Beyond low tidal volumes: ventilating the patient with acute respiratory distress syndrome.

The cornerstone of lung protective ventilation in patients with acute respiratory distress syndrome (ARDS) is a pressure- and volume-limited strategy. Other interventions have also been investigated. Although no method for positive end-expiratory pressure (PEEP) titration has proven most advantageous, experimental and clinical data support the use of higher PEEP in patients with moderate/severe ARDS. There is no benefit to the early use of high-frequency oscillatory ventilation (HFOV) in patients with moderate/severe ARDS, although it may be considered as rescue therapy. Further investigations of novel methods of bedside monitoring of mechanical ventilation may help identify the optimal ventilatory strategy.