Spontaneous breathing activity in acute lung injury and acute respiratory distress syndrome

Current Opinion in Anesthesiology, 03/28/2012

In patients with acute lung injury (ALI) and acute respiratory distress syndrome (ARDS), unsupported spontaneous breathing in combination with mandatory cycles has been shown to improve lung function, reduce the need for sedation and cardiocirculatory drug therapy, and speed weaning, with no effect on mortality. On the other hand, strong clinical evidence shows that the use of neuromuscular blocking agents in the first 48h of mechanical ventilation with the volume assist–control ventilation mode reduces morbidity and mortality in severe ARDS compared to placebo. Spontaneous breathing activity should be avoided in the first 48h of mechanical ventilation in patients with severe ARDS, but it may be useful in less severe ARDS and ALI.

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