Abstract
Ventilatory therapy plays a critical role in managing patients with Acute Respiratory Distress Syndrome (ARDS). The primary goal of ventilator therapy is to assist in ventilation while preventing ventilator-induced lung injury (VILI) and ventilator-induced diaphragm dysfunction (VIDD). Volutrauma and atelectrauma are the main mechanisms responsible for VILI. Recently, respiratory rate and flow rate have been highlighted as possible elements contributing to VILI, and the concept of mechanical power was proposed. Once patients are able to breathe spontaneously, efforts should focus on avoiding patient self-inflicted lung injury (P-SILI). Prolonged paralysis of the diaphragm or patient-ventilator dyssynchrony can lead to VIDD or P-SILI. To achieve less injurious ventilation, careful selection of Positive End-Expiratory Pressure (PEEP) and tidal volume is crucial. However, determining the optimal ventilator settings remains a challenge, as it depends on the specific characteristics of each patient and the judgment of the physician. Therefore, critical care physicians should have a comprehensive understanding of the pathophysiological basis of ARDS and be aware of the current consensus regarding ventilator management for these patients.