Non-ventilatory strategies for ARDS
reducing dead space
hypercapnea caused by:
- hypoventilation
- high RR (to maintain minute volume with a lower tidal volume) → incomplete CO2 exhalation
- dead space
- hypermetabolic/catabolic state
Neuromuscular blockade
why?
- improves chest wall compliance
- improve synchrony without sacrificing haemodynamics because of sedation
key trial: ACURASYS
fluid management
ARDSNet - found that conservative management (i.e. keeping them dry) had less ventilator days
(although the trial based fluid status on CVP!)
other therapies
ECMO - CESAR trial