Customization of an open-lung ventilation strategy to treat a case of life-threatening acute respiratory distress syndrome

Respir Care. 2011 Apr;56(4):514-9. doi: 10.4187/respcare.00867. Epub 2011 Jan 21.


The ARDS Network low-tidal-volume protocol is considered the standard of care for patients with acute lung injury (ALI) or acute respiratory distress syndrome (ARDS). The protocol is built on the foundation of low-tidal-volume ventilation, use of a combined PEEP and F(IO(2)) table, and managing alveolar end-inspiratory pressure by limiting the plateau airway pressure to ≤ 30 cm H(2)O. Although this strategy, to date, is the only method that significantly improves ALI/ARDS survival, alternative methods of improving hypoxemia and minimizing ventilator-induced lung injury, in conjunction with low-tidal-volume ventilation, can be used for life-threatening ARDS. We present a case in which we customized the use of alveolar recruitment maneuvers by analyzing the hysteresis of the pressure-volume curve to assess lung recruitability, decremental PEEP to sustain lung recruitment, and careful use of plateau pressure ≥ 30 cm H(2)O, which improved our patient's life-threatening hypoxemia within the first 36 min of arrival to our ICU.

Publication types

  • Case Reports

MeSH terms

  • Adult
  • Algorithms
  • Female
  • Humans
  • Positive-Pressure Respiration / methods*
  • Respiratory Distress Syndrome / therapy*