Implementation of protective mechanical ventilation in patients with acute respiratory distress syndrome Narrative review
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Abstract
Protective mechanical ventilation has been shown to reduce mortality in patients with acute respiratory distress syndrome. However, many patients do not receive adequate treatment or ventilatory monitoring.
The implementation of mechanical ventilation can be improved by applying concepts and tools described in published protocols. The preparation of the ventilator, the respiratory circuit and the interfaces allow correcting the compressible volume, conditioning the inspired gas, and minimizing the instrumental dead space.
The choice of the ventilatory mode, the initial tidal volume and respiratory rate allow to ensure correct minute ventilation. The positive end-expiratory pressure and the inspired fraction of oxygen are the most relevant variables to maintain adequate oxygenation. Monitoring respiratory mechanics, gas exchange, and patient-ventilator synchrony makes it possible to assess the response to therapeutic interventions, detect complications, and make corrections. The detection of the opportune moment to initiate the transition from controlled ventilation to the phase of partial ventilatory support and the initiation of weaning is an important challenge to reduce the risks associated with the prolonged duration of mechanical ventilation.
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