Spontaneous breathing in mild and moderate versus severe acute respiratory distress syndrome

Abstract

Clinical and experimental studies show that controlled mechanical ventilation with muscle paralysis in the early phase of severe ARDS reduces lung injury and even mortality. At present, spontaneous breathing should be avoided in the early phase of severe ARDS, but considered in mild-to-moderate ARDS.

Extracorporeal techniques in acute respiratory distress syndrome

“…Additionally, it could optimize other intensive care-based management strategies, including minimization of sedation, reductions in nosocomial infections (particularly ventilator-associated pneumonia) and maximization of mobilization and enteral nutrition. However, there is potential concern over exacerbating mechanical stress with spontaneous breathing in ARDS (61)(62)(63)(64)(65). Although ECCO 2 R has been shown to have the ability to control ventilatory drive in select patients with severe, chronic respiratory failure (e.g., COPD), data suggests that it may not be able to sufficiently control the spontaneous and potentially injurious respiratory efforts of patients with severe ARDS (66,67).…”

Variability in Mechanical Ventilation: What's All the Noise About?

“…In the former, the pressure support is proportional to the instantaneous flow and volume requirement. 47 In contrast with the neurally adjusted ventilatory assist mode, the level of inspiratory support is related to the electrical inspiratory activity of the diaphragm. 47 Both modes of ventilation yield a highly variable V T pattern and can initiate the beneficial effects of noise and stochastic resonance.…”

“…44 In the absence of severe ARDS requiring muscle paralysis and controlled mechanical ventilation, rapidly transitioning to patient-triggered or spontaneous modes of ventilation has multiple benefits. 47 Both patient-triggered ventilation and spontaneous ventilation facilitate better ventilation/perfusion matching, reduce ventilator-induced lung injury, and preserve diaphragmatic function. [48][49][50] Furthermore, patient-triggered ventilation modes can potentially yield a highly variable respiratory pattern, akin to the experimental variable ventilation studies reported previously.…”

Extracorporeal Circulatory Approaches to Treat Acute Respiratory Distress Syndrome

“…However, spontaneous breathing may exacerbate lung injury by increasing mechanical stress. 73,74 There is limited experience with spontaneous breathing, with or without invasive mechanical ventilation, during extracorporeal support for severe ARDS, [74][75][76] and further study is needed before any recommendations can be made.…”