Tayyba Naz Aslam1,2, Thomas Lass Klitgaard3,4, Kristin Hofsø2,5, Bodil Steen Rasmussen3,4, Jon Henrik Laake1,2. 1. Department of Anaesthesiology, Division of Emergencies and Critical Care, Rikshospitalet Medical Centre, Oslo University Hospital, P.O.Box 4950, Nydalen, Oslo, Norway. 2. Department of Research and Development, Division of Emergencies and Critical Care, Oslo University Hospital, Oslo, Norway. 3. Department of Anaesthesia and Intensive Care Medicine, Aalborg University Hospital, Aalborg, Denmark. 4. Department of Clinical Medicine, Aalborg University, Aalborg, Denmark. 5. Lovisenberg Diaconal University College, Oslo, Norway.
Abstract
PURPOSE OF REVIEW: To review clinical evidence on whether or not to allow mechanically ventilated patients with acute respiratory distress syndrome (ARDS) to breathe spontaneously. RECENT FINDINGS: Observational data (LUNG SAFE study) indicate that mechanical ventilation allowing for spontaneous breathing (SB) is associated with more ventilator-free days and a shorter stay in the intensive care unit without any effect on hospital mortality. A paediatric trial, comparing airway pressure release ventilation (APRV) and low-tidal volume ventilation, showed an increase in mortality in the APRV group. Conversely, in an unpublished trial comparing SB and controlled ventilation (NCT01862016), the authors concluded that SB is feasible but did not improve outcomes in ARDS patients. SUMMARY: A paucity of clinical trial data continues to prevent firm guidance on if or when to allow SB during mechanical ventilation in patients with ARDS. No published large randomised controlled trial exists to inform practice about the benefits and harms of either mode.
PURPOSE OF REVIEW: To review clinical evidence on whether or not to allow mechanically ventilated patients with acute respiratory distress syndrome (ARDS) to breathe spontaneously. RECENT FINDINGS: Observational data (LUNG SAFE study) indicate that mechanical ventilation allowing for spontaneous breathing (SB) is associated with more ventilator-free days and a shorter stay in the intensive care unit without any effect on hospital mortality. A paediatric trial, comparing airway pressure release ventilation (APRV) and low-tidal volume ventilation, showed an increase in mortality in the APRV group. Conversely, in an unpublished trial comparing SB and controlled ventilation (NCT01862016), the authors concluded that SB is feasible but did not improve outcomes in ARDS patients. SUMMARY: A paucity of clinical trial data continues to prevent firm guidance on if or when to allow SB during mechanical ventilation in patients with ARDS. No published large randomised controlled trial exists to inform practice about the benefits and harms of either mode.
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