What is the optimal respiratory monitoring strategy in ALI/ARDS?

What is the optimal respiratory monitoring strategy in ALI/ARDS? - SUMMARY • The actual target of mechanical ventilation is lung protection from VILI, triggered by transpulmonary pressure (stress), and the associated strain. • The greater the lung injury severity (assessed by CT scan), the smaller the baby lung, and the greater the stress-strain induced by mechanical ventilation. • The use of the lowest tidal volume possible it is now widely accepted. On the contrary, no survival benefits have been found comparing lower versus higher PEEP randomly applied to unselected ARDS populations, while benefits of higher PEEP were found in the most severe ones. • The least harmful mechanical ventilation should be based assessing individual patients characteristics, providing the lowest stress and strain • Associated therapies as prone positioning and extra-corporeal support must be sought on, in the most severe ARDS patients where mechanical ventilation is more harmful. What is the optimal respiratory monitoring strategy in ALI/ARDS? – TAKE HOME MESSAGE When setting mechanical ventilation first consider the “baby lung” size. Whatever it is always use low tidal volume, if very small (resulting in severe ARDS), use prone position and consider extra-corporeal support