Adult Respiratory Distress Syndrome: Therapy

General measures

  • The most important measure is to eliminate the underlying cause.
  • Review of permanent medication due topossible effect on the existing disease.

Intensive medical treatment with the following therapeutic measures:

  • Ventilation therapylung-protective mechanical ventilation with tidal volume* ≤ 6 ml/kg standard body weight, low peak pressure (< 30 mbar) and PEEP (“Positive End-Expiratory Pressure”, Engl. (positive end-expiratory pressure) 9-12 mbar; early spontaneous breathing (under BIPAP; an upper and lower ventilation pressure is set and the change between both pressure levels corresponds to inspiration and expiration; biphasic positive airway pressure) and prone position (see below for positioning therapy)Note: High-frequency ventilation is not recommended in adult patients with ARDS. Notice. Lung protective ventilation is generally considered more important than immediate correction of hypoxemia (lack of oxygen in the blood). * Tidal volume (VT) corresponds to the volume of air per breath.
  • Fluid restriction
  • Positioning therapy – with the upper body elevated; if necessary, intermittent prone position: therapy trial at paO2/FIO2 < 150 mmHg.
  • Drug therapy (inhaled vasodilators).
  • Other options include ECMO (extracorporeal membrane oxygenation/lung assist therapy), pECLA (pumpless extracorporeal lung assist), or HFOV (high-frequency oscillation ventilation)
    • ECMO for severe ARDS as salvage therapy.

Further notes

  • The mechanical variables of mechanical ventilation (mechanical power: product of respiratory rate, tidal volume, peak pressure, and drive pressure) are among the factors that determine mortality (death rate) in patients with respiratory insufficiency (disruption of lung gas exchange with abnormally altered blood gas levels). A dose-response relationship has been demonstrated. The mechanical power parameters described are surrogate parameters; alveolar pressure (pressure in the alveoli) is crucial for lung damage caused by mechanical ventilation.CONCLUSION: Limiting drive pressure and mechanical power probably reduces mortality in ventilated patients.
  • In patients with acute hypoxic respiratory failure (drop in partial pressure of oxygen in arterial blood, but partial pressure of carbon dioxide can still be compensated), oxygenation (saturation of tissues with oxygen) with a respiratory helmet or face mask reduces patient mortality compared with standard administration of oxygen. Furthermore, helmet, mask, and nasal high-flow oxygenation reduce the risk of intubation (insertion of a tube (a hollow probe) into the trachea/trachea).