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World J Crit Care Med. Feb 4, 2016; 5(1): 74-82
Published online Feb 4, 2016. doi: 10.5492/wjccm.v5.i1.74
Preemptive mechanical ventilation can block progressive acute lung injury
Benjamin Sadowitz, Sumeet Jain, Michaela Kollisch-Singule, Joshua Satalin, Penny Andrews, Nader Habashi, Louis A Gatto, Gary Nieman
Benjamin Sadowitz, the Southeastern Center for Digestive Disorders and Pancreatic Cancer, Advanced Minimally Invasive and Robotic Surgery, Florida Hospital Tampa, Tampa, FL 33613, United States
Sumeet Jain, Michaela Kollisch-Singule, Joshua Satalin, Gary Nieman, Department of Surgery, Upstate Medical University, Syracuse, NY 13210, United States
Penny Andrews, Nader Habashi, Critical Care Medicine, Surgical Critical Care, Trauma Critical Care Medicine, The R Adams Cowley Shock Trauma Center, University of Maryland, Baltimore, MD 21201, United States
Louis A Gatto, Biological Sciences Department, SUNY Cortland, Cortland, NY 13045, United States
Author contributions: Sadowitz B contributed to acquisition of data, data interpretation and analysis, drafting the manuscript; Jain S, Kollisch-Singule M, Satalin J, Andrews P, Habashi N, Gatto LA and Nieman G contributed to data interpretation and analysis, critical revision of the manuscript.
Conflict-of-interest statement: We have no conflict of interests to disclose.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Joshua Satalin, Lab Manager (Cardiopulmonary Critical Care Lab), Department of Surgery, Upstate Medical University, 750 East Adams Street, Syracuse, NY 13210, United States. satalinj@upstate.edu
Telephone: +1-315-4641696
Received: June 10, 2015
Peer-review started: June 11, 2015
First decision: August 16, 2015
Revised: October 15, 2015
Accepted: December 29, 2015
Article in press: January 4, 2016
Published online: February 4, 2016
Abstract

Mortality from acute respiratory distress syndrome (ARDS) remains unacceptable, approaching 45% in certain high-risk patient populations. Treating fulminant ARDS is currently relegated to supportive care measures only. Thus, the best treatment for ARDS may lie with preventing this syndrome from ever occurring. Clinical studies were examined to determine why ARDS has remained resistant to treatment over the past several decades. In addition, both basic science and clinical studies were examined to determine the impact that early, protective mechanical ventilation may have on preventing the development of ARDS in at-risk patients. Fulminant ARDS is highly resistant to both pharmacologic treatment and methods of mechanical ventilation. However, ARDS is a progressive disease with an early treatment window that can be exploited. In particular, protective mechanical ventilation initiated before the onset of lung injury can prevent the progression to ARDS. Airway pressure release ventilation (APRV) is a novel mechanical ventilation strategy for delivering a protective breath that has been shown to block progressive acute lung injury (ALI) and prevent ALI from progressing to ARDS. ARDS mortality currently remains as high as 45% in some studies. As ARDS is a progressive disease, the key to treatment lies with preventing the disease from ever occurring while it remains subclinical. Early protective mechanical ventilation with APRV appears to offer substantial benefit in this regard and may be the prophylactic treatment of choice for preventing ARDS.

Keywords: Mechanical ventilation, Acute lung injury, Acute respiratory distress syndrome, Airway pressure release ventilation

Core tip: Mortality from acute respiratory distress syndrome (ARDS) remains unacceptably high. Treating fulminant ARDS, however, is currently relegated to supportive care measures only. Thus, the best treatment for ARDS may lie with preventive measures. Indeed, since ARDS is a progressive disease, treating this disease in its subclinical phases may prevent the disease from ever occurring. In this regard, early protective mechanical ventilation with airway pressure release ventilation appears to offer substantial benefit and may be the prophylactic treatment of choice for preventing ARDS.