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Critical Care Research and Practice
Volume 2012 (2012), Article ID 952168, 13 pages
http://dx.doi.org/10.1155/2012/952168
Review Article

Goal-Oriented Respiratory Management for Critically Ill Patients with Acute Respiratory Distress Syndrome

1Respiratory ICU and LIM-09, Medical School, University of São Paulo, 6 Andar, Avenida Dr. Eneas de Carvalho Aguiar 155, 05403-000 São Paulo, SP, Brazil
2Adult ICU Albert Einstein Hospital, 5 Andar, Avenida Albert Einstein 627, 05652-900 São Paulo, SP, Brazil

Received 2 June 2012; Accepted 19 July 2012

Academic Editor: Lars J. Bjertnaes

Copyright © 2012 Carmen Sílvia Valente Barbas et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

This paper, based on relevant literature articles and the authors' clinical experience, presents a goal-oriented respiratory management for critically ill patients with acute respiratory distress syndrome (ARDS) that can help improve clinicians' ability to care for these patients. Early recognition of ARDS modified risk factors and avoidance of aggravating factors during hospital stay such as nonprotective mechanical ventilation, multiple blood products transfusions, positive fluid balance, ventilator-associated pneumonia, and gastric aspiration can help decrease its incidence. An early extensive clinical, laboratory, and imaging evaluation of “at risk patients” allows a correct diagnosis of ARDS, assessment of comorbidities, and calculation of prognostic indices, so that a careful treatment can be planned. Rapid administration of antibiotics and resuscitative measures in case of sepsis and septic shock associated with protective ventilatory strategies and early short-term paralysis associated with differential ventilatory techniques (recruitment maneuvers with adequate positive end-expiratory pressure titration, prone position, and new extracorporeal membrane oxygenation techniques) in severe ARDS can help improve its prognosis. Revaluation of ARDS patients on the third day of evolution (Sequential Organ Failure Assessment (SOFA), biomarkers and response to infection therapy) allows changes in the initial treatment plans and can help decrease ARDS mortality.