Respiratory mechanics to understand ARDS and guide mechanical ventilation

Tommaso Mauri, Marta Lazzeri, Giacomo Bellani, Alberto Zanella, Giacomo Grasselli

Research output: Contribution to journalArticle

Abstract

Objective: As precision medicine is becoming a standard of care in selecting tailored rather than average treatments, physiological measurements might represent the first step in applying personalized therapy in the intensive care unit (ICU). A systematic assessment of respiratory mechanics in patients with the acute respiratory distress syndrome (ARDS) could represent a step in this direction, for two main reasons. Approach and Main results: On the one hand, respiratory mechanics are a powerful physiological method to understand the severity of this syndrome in each single patient. Decreased respiratory system compliance, for example, is associated with low end expiratory lung volume and more severe lung injury. On the other hand, respiratory mechanics might guide protective mechanical ventilation settings. Improved gravitationally dependent regional lung compliance could support the selection of positive end-expiratory pressure and maximize alveolar recruitment. Moreover, the association between driving airway pressure and mortality in ARDS patients potentially underlines the importance of sizing tidal volume on respiratory system compliance rather than on predicted body weight. Significance: The present review article aims to describe the main alterations of respiratory mechanics in ARDS as a potent bedside tool to understand severity and guide mechanical ventilation settings, thus representing a readily available clinical resource for ICU physicians.

Original languageEnglish
Pages (from-to)R280-R303
JournalPhysiological Measurement
Volume38
Issue number12
DOIs
Publication statusPublished - Nov 28 2017

Keywords

  • acute respiratory distress syndrome
  • compliance, resistance
  • positive end-expiratory pressure
  • respiratory physiology
  • transpulmonary pressure

ASJC Scopus subject areas

  • Biophysics
  • Physiology
  • Biomedical Engineering
  • Physiology (medical)

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