Open Lung in ARDS.

Every year, millions of patients worldwide receive ventilator support during surgery. Mechanical ventilation has become an important therapy in the treatment of patients with impaired pulmonary function and particularly in patients suffering from adult respiratory distress syndrome (ARDS). ARDS is caused by multiple factors and is characterized by respiratory dysfunction including hypoxemia and decreased lung compliance. It is known that the decrease in lung distensibility is due to a disturbed surfactant system with an elevated surface tension. This increase in surface tension leads to an increase in forces acting at the air-liquid interface, resulting finally in endexpiratory collapse, atelectasis, an increase in right-to-left shunt and a decrease in paO2.

[1]  J. Lyszczarz,et al.  [Mechanical properties of the lungs]. , 1971, Acta physiologica Polonica.

[2]  B Jonson,et al.  Modes of artificial ventilation in severe respiratory distress syndrome. Lung function and morphology in rabbits after wash‐out of alveolar surfactant , 1982, Critical care medicine.

[3]  A. Froese,et al.  Volume recruitment maneuvers are less deleterious than persistent low lung volumes in the atelectasisprone rabbit lung during high‐frequency oscillation , 1993, Critical care medicine.

[4]  M. Amato,et al.  Beneficial effects of the "open lung approach" with low distending pressures in acute respiratory distress syndrome. A prospective randomized study on mechanical ventilation. , 1995, American journal of respiratory and critical care medicine.

[5]  D. Gommers,et al.  Surfactant impairment after mechanical ventilation with large alveolar surface area changes and effects of positive end-expiratory pressure. , 1998, British journal of anaesthesia.

[6]  Arthur S Slutsky,et al.  Effect of mechanical ventilation on inflammatory mediators in patients with acute respiratory distress syndrome: a randomized controlled trial. , 1999, JAMA.

[7]  International consensus conferences in intensive care medicine. Ventilator-associated lung injury in ARDS. American Thoracic Society, European Society of Intensive Care Medicine, Societé de Réanimation Langue Française. , 1999, Intensive care medicine.

[8]  Arthur S Slutsky,et al.  Mechanical ventilation as a mediator of multisystem organ failure in acute respiratory distress syndrome. , 2000, JAMA.

[9]  D. Schoenfeld,et al.  Ventilation with lower tidal volumes as compared with traditional tidal volumes for acute lung injury and the acute respiratory distress syndrome. , 2000, The New England journal of medicine.

[10]  D. Gommers,et al.  At surfactant deficiency, application of "the open lung concept" prevents protein leakage and attenuates changes in lung mechanics , 2000, Critical care medicine.

[11]  C. Josten,et al.  [The open lung concept. Clinical application in severe thoracic trauma]. , 2002, Der Chirurg; Zeitschrift fur alle Gebiete der operativen Medizen.