A modern ventilatory strategy in acute respiratory distress syndrome: let the right ventricle breathe!

Abstract

Mechanical ventilation of patients with acute respiratory distress syndrome (ARDS) has significantly changed since 20 years. Its potential deleterious effects have been better understood and described. The spread of echocardiography in the intensive care unit allowed describing a high incidence of acute cor pulmonale in these patients and its impact on mortality. Thus, we have to pay caution to the right ventricle (RV) and protect it in the ventilatory strategy. This leads to monitor and control all the parameters responsible for increased RV afterload. In this short review, we describe a new approach of ARDS management allowing limiting the deleterious effects of mechanical ventilation on the RV, including the strict limitation of plateau pressure and driving pressure, control of hypercapnia, and use of prone position rather than high positive end-expiratory pressure (PEEP) in most hypoxic patients.