Acute respiratory distress syndrome: ways to optimize respiratory support depending on breathing pattern and mechanics

Abstract

The article provides an overview of the management of acute respiratory distress syndrome depending on
breathing mechanics and patterns. Best practices include using low tidal volume, low plateau and driving
pressure, and maintaining high levels of positive end-expiratory pressure. Collectively, all this is called “lung
protective ventilation”. Individualized selection of ventilation parameters including breathing pattern can
be used to adjust ventilation parameters and improve the results of respiratory support than the “working”
standards of protective lung ventilation. This review describes the measurement and applying of clinically
applicable pulmonary mechanics concepts such as plateau pressure, driving pressure, and transpulmonary
pressure. Article discusses the concept of a stress index and its role in breathing mechanics in normal and
pathology