Over the last 15 years it has been clearly established in numerous animal models that some approaches to mechanical ventilation can induce lung injury [1] and clinical data have demonstrated improved mortality when a lung protective ventilatory strategy is employed [2, 3]. However, overall mortality in acute respriratory distress syndrome (ARDS) is still about 40% [4, 5]. As a result, investigations focusing on approach and adjuncts to ventilatory support are still ongoing. Throughoutthis text, data on alternate modes ofventilation, such as high frequency oscillatory ventilation (HFOV), airway pressure release ventilation (APRV) and bilevel ventilation, as well as prone positioning have been presented. In this chapter, a review of the current status of tracheal gas insufflation (TGI), partial liquid ventilation (PLV), inhaled nitric oxide (NO), and the less well developed concept of integrating biological variability into ventilatory support are presented.

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