University Hospital Würzburg, Department of Anaesthesiology, Intensive Care, Emergency and Pain Medicine, Oberdürrbacher Str. 6, 97080, Würzburg, Germany.
Crit Care. 2023 Mar 14;27(1):111. doi: 10.1186/s13054-023-04375-z.
The current ARDS guidelines highly recommend lung protective ventilation which include plateau pressure (P < 30 cm HO), positive end expiratory pressure (PEEP > 5 cm HO) and tidal volume (V of 6 ml/kg) of predicted body weight. In contrast, the ELSO guidelines suggest the evaluation of an indication of veno-venous extracorporeal membrane oxygenation (ECMO) due to hypoxemic or hypercapnic respiratory failure or as bridge to lung transplantation. Finally, these recommendations remain a wide range of scope of interpretation. However, particularly patients with moderate-severe to severe ARDS might benefit from strict adherence to lung protective ventilation strategies. Subsequently, we discuss whether extended physiological ventilation parameter analysis might be relevant for indication of ECMO support and can be implemented during the daily routine evaluation of ARDS patients. Particularly, this viewpoint focus on driving pressure and mechanical power.
目前的急性呼吸窘迫综合征指南强烈推荐肺保护性通气，包括平台压（P < 30 cmH2O）、呼气末正压（PEEP > 5 cmH2O）和预测体重的潮气量（6 ml/kg）。相比之下，ELSO 指南建议评估由于低氧血症或高碳酸血症性呼吸衰竭或作为肺移植桥接而进行的静脉-静脉体外膜氧合（ECMO）的适应证。最后，这些建议仍然存在广泛的解释范围。然而，特别是中重度至重度急性呼吸窘迫综合征患者可能受益于严格遵守肺保护性通气策略。随后，我们讨论了扩展生理通气参数分析是否与 ECMO 支持的适应证相关，并且可以在急性呼吸窘迫综合征患者的日常常规评估中实施。特别是，这一观点侧重于驱动压力和机械功率。
