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Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Respirol. Nov 28, 2015; 5(3): 188-198
Published online Nov 28, 2015. doi: 10.5320/wjr.v5.i3.188
Reducing acute respiratory distress syndrome occurrence using mechanical ventilation
Gary F Nieman, Louis A Gatto, Nader M Habashi
Gary F Nieman, Department of Surgery, Upstate Medical University, Syracuse, NY 13210, United States
Louis A Gatto, Biology Department, SUNY Cortland, Cortland, NY 13210, United States
Nader M Habashi, Department of Trauma Critical Care Medicine, R Adams Cowley Shock Trauma Center, Baltimore, MD 21201, United States
Author contributions: Nieman GF, Gatto LA, Habashi NM wrote the paper.
Conflict-of-interest statement: The authors declare no conflicts of interest.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Gary F Nieman, BA, Department of Surgery, Upstate Medical University, 750 E Adams St Ste 329, Syracuse, NY 13210, United States. niemang@upstate.edu
Telephone: +1-315-4646302 Fax: +1-315-4646294
Received: March 14, 2015
Peer-review started: March 16, 2015
First decision: April 27, 2015
Revised: July 1, 2015
Accepted: July 16, 2015
Article in press: July 17, 2015
Published online: November 28, 2015
Processing time: 261 Days and 6.2 Hours
Abstract

The standard treatment for acute respiratory distress syndrome (ARDS) is supportive in the form of low tidal volume ventilation applied after significant lung injury has already developed. Nevertheless, ARDS mortality remains unacceptably high (> 40%). Indeed, once ARDS is established it becomes refractory to treatment, and therefore avoidance is key. However, preventive techniques and therapeutics to reduce the incidence of ARDS in patients at high-risk have not been validated clinically. This review discusses the current data suggesting that preemptive application of the properly adjusted mechanical breath can block progressive acute lung injury and significantly reduce the occurrence of ARDS.

Keywords: Acute respiratory distress syndrome; Ventilator induced lung injury; Early acute lung injury; Mechanical ventilation; Acute respiratory distress syndrome incidence; Airway pressure release ventilation; Acute respiratory distress syndrome pathophysiology

Core tip: In all patients at risk of developing acute lung injury or acute respiratory distress syndrome (ARDS), protective mechanical ventilation should be applied immediately upon intubation. However, the optimally protective breath to block progressive acute lung injury is not known. Recent clinical studies have shown that preemptive low tidal volume can both reduce and increase mortality. Application of preemptive airway pressure release ventilation has shown a great deal of promise at reducing ARDS occurrence in both animal and clinical studies.