Personalized Respiratory Support in ARDS: A Physiology-to-Bedside Review

Author:

Cutuli Salvatore Lucio12ORCID,Grieco Domenico Luca12ORCID,Michi Teresa12,Cesarano Melania12,Rosà Tommaso12ORCID,Pintaudi Gabriele12,Menga Luca Salvatore12,Ruggiero Ersilia12,Giammatteo Valentina12,Bello Giuseppe12,De Pascale Gennaro12ORCID,Antonelli Massimo12

Affiliation:

1. Department of Emergency, Intensive Care Medicine and Anesthesia, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy

2. Istituto di Anestesiologia e Rianimazione, Università Cattolica del Sacro Cuore, 00168 Rome, Italy

Abstract

Acute respiratory distress syndrome (ARDS) is a leading cause of disability and mortality worldwide, and while no specific etiologic interventions have been shown to improve outcomes, noninvasive and invasive respiratory support strategies are life-saving interventions that allow time for lung recovery. However, the inappropriate management of these strategies, which neglects the unique features of respiratory, lung, and chest wall mechanics may result in disease progression, such as patient self-inflicted lung injury during spontaneous breathing or by ventilator-induced lung injury during invasive mechanical ventilation. ARDS characteristics are highly heterogeneous; therefore, a physiology-based approach is strongly advocated to titrate the delivery and management of respiratory support strategies to match patient characteristics and needs to limit ARDS progression. Several tools have been implemented in clinical practice to aid the clinician in identifying the ARDS sub-phenotypes based on physiological peculiarities (inspiratory effort, respiratory mechanics, and recruitability), thus allowing for the appropriate application of personalized supportive care. In this narrative review, we provide an overview of noninvasive and invasive respiratory support strategies, as well as discuss how identifying ARDS sub-phenotypes in daily practice can help clinicians to deliver personalized respiratory support and potentially improve patient outcomes.

Funder

institutional and departmental resources

Publisher

MDPI AG

Subject

General Medicine

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