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Title: Personalized mechanical ventilation in acute respiratory distress syndrome.
Austin Authors: Pelosi, Paolo;Ball, Lorenzo;Barbas, Carmen S V;Bellomo, Rinaldo ;Burns, Karen E A;Einav, Sharon;Gattinoni, Luciano;Laffey, John G;Marini, John J;Myatra, Sheila N;Schultz, Marcus J;Teboul, Jean Louis;Rocco, Patricia R M
Affiliation: Department of Critical Care, The University of Melbourne, Melbourne, Australia
Data Analytics Research and Evaluation (DARE) Centre
Department of Intensive Care, Royal Melbourne Hospital, Melbourne, VIC, Australia
Anesthesia and Intensive Care, San Martino Policlinico Hospital, IRCCS for Oncology and Neuroscience, Genoa, Italy
Department of Surgical Sciences and Integrated Diagnostic (DISC), University of Genoa, Viale Benedetto XV 16, Genoa, Italy
Service de Médecine Intensive-Réanimation, Hôpital Bicêtre, Inserm UMR S_999, AP-HP Université Paris-Saclay, Le Kremlin-Bicêtre, France
Laboratory of Pulmonary Investigation, Carlos Chagas Filho Institute of Biophysics, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
Department of Anaesthesiology, Critical Care and Pain, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, India
Mahidol Oxford Tropical Medicine Research Unit (MORU), Mahidol University, Bangkok, Thailand
Department of Intensive Care, Amsterdam University Medical Centers, Amsterdam, The Netherlands
Nuffield Department of Medicine, University of Oxford, Oxford, UK
Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON, Canada
Unity Health Toronto-St. Michael's Hospital, Li Ka Shing Knowledge Institute, Toronto, ON, Canada
Intensive Care Unit of the Shaare Zedek Medical Medical Centre, Hebrew University Faculty of Medicine, Jerusalem, Israel
Department of Anaesthesiology, Emergency, and Intensive Care Medicine, University of Göttingen, Göttingen, Germany
Anaesthesia and Intensive Care Medicine, University Hospital Galway, and School of Medicine, National University of Ireland, Galway, Ireland
University of Minnesota and Regions Hospital, St. Paul, MN, USA
Pneumology and Intensive Care Medicine, University of São Paulo, São Paulo, Brazil
Adult Intensive Care Unit, Albert Einstein Hospital, São Paulo, Brazil
Intensive Care
Department of Epidemiology and Preventive Medicine, Australian and New Zealand Intensive Care Research Centre, Monash University, Melbourne, VIC, Australia
Issue Date: 16-Jul-2021
Date: 2021
Publication information: Critical Care 2021; 25(1): 250
Abstract: A personalized mechanical ventilation approach for patients with adult respiratory distress syndrome (ARDS) based on lung physiology and morphology, ARDS etiology, lung imaging, and biological phenotypes may improve ventilation practice and outcome. However, additional research is warranted before personalized mechanical ventilation strategies can be applied at the bedside. Ventilatory parameters should be titrated based on close monitoring of targeted physiologic variables and individualized goals. Although low tidal volume (VT) is a standard of care, further individualization of VT may necessitate the evaluation of lung volume reserve (e.g., inspiratory capacity). Low driving pressures provide a target for clinicians to adjust VT and possibly to optimize positive end-expiratory pressure (PEEP), while maintaining plateau pressures below safety thresholds. Esophageal pressure monitoring allows estimation of transpulmonary pressure, but its use requires technical skill and correct physiologic interpretation for clinical application at the bedside. Mechanical power considers ventilatory parameters as a whole in the optimization of ventilation setting, but further studies are necessary to assess its clinical relevance. The identification of recruitability in patients with ARDS is essential to titrate and individualize PEEP. To define gas-exchange targets for individual patients, clinicians should consider issues related to oxygen transport and dead space. In this review, we discuss the rationale for personalized approaches to mechanical ventilation for patients with ARDS, the role of lung imaging, phenotype identification, physiologically based individualized approaches to ventilation, and a future research agenda.
DOI: 10.1186/s13054-021-03686-3
Journal: Critical Care
PubMed URL: 34271958
Type: Journal Article
Subjects: Biomarkers
Chest computed tomography scan
Driving pressure
Tidal volume
Transpulmonary pressure
Appears in Collections:Journal articles

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