Standard of Care for Ventilation Strategy of ARDS

ARDS is a life-threatening condition characterized by an acute hypoxemia and respiratory distress and which most often requires mechanical ventilation [13]. A lung-protective ventilation strategy is now proposed as a standard of care for patients presenting ARDS relying on the use of low tidal volume (6 mLkg-1 predicted body weight) and positive end-expiratory pressure and limiting the inspiratory plateau pressure to <28-30 cmH2O. Probably by optimizing lung-protective ventilation, there is some evidence that the use of neuromuscular-blocking agents at the early phase of ARDS may be beneficial [15]. The cost of such protective strategy may be a complete inactivity of the diaphragm and of the other respiratory muscles that may lead to disuse atrophy and muscle weakness [1]. This can contribute to difficulties in separating patients from the ventilator, prolongation of mechanical ventilation, and poorer prognosis. Hence, there has been a huge interest in the use of noninvasive ventilatory supports such as NIV and HFNC.

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