Selected article for: "ARDS Network protocol and mechanical ventilation"
Author: Bein, Thomas; Grasso, Salvatore; Moerer, Onnen; Quintel, Michael; Guerin, Claude; Deja, Maria; Brondani, Anita; Mehta, Sangeeta
Title: The standard of care of patients with ARDS: ventilatory settings and rescue therapies for refractory hypoxemia
  • Document date: 2016_4_4
    • ID: krpg9u1u_20
    Snippet: At present, the only evidence-based protocol for setting PEEP is the one proposed by the ARDS Network (ARD-SNet) in a pivotal study [8] . However in that study the PEEP and FiO 2 combination was the same for the control and study arm and LRMs were not permitted. Overall, the ARDSNet protocol just "tolerates" atelectasis by applying the minimal PEEP and FiO 2 to match an acceptable (but rather low) arterial oxygenation target (between 55 and 80 mm.....
    Document: At present, the only evidence-based protocol for setting PEEP is the one proposed by the ARDS Network (ARD-SNet) in a pivotal study [8] . However in that study the PEEP and FiO 2 combination was the same for the control and study arm and LRMs were not permitted. Overall, the ARDSNet protocol just "tolerates" atelectasis by applying the minimal PEEP and FiO 2 to match an acceptable (but rather low) arterial oxygenation target (between 55 and 80 mmHg). Nevertheless, two major issues remain controversial: prevention of the main VILI mechanisms (tidal recruitment and hyperinflation) [9] , and the best "rescue" protocol to be adopted if the ARDSNet protocol fails (i.e., if oxygenation targets are not reached within the PEEP/FiO 2 and/or inspiratory plateau pressure limits imposed by the protocol). The overall side effects and complications associated with mechanical ventilation are summarized in Table 1 .

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