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Ventilatory Strategies in ARDS

Ventilatory strategies in Acute Respiratory Distress Syndrome (ARDS) are crucial for optimizing oxygenation and minimizing further lung injury. Ventilating with low tidal volumes (6 mL/kg of predicted body weight or lower) reduces the risk of ventilator-induced lung injury (VILI).  PEEP is used to maintain alveolar recruitment and improve oxygenation while preventing lung collapse during expiration.  A lung-protective ventilation strategy combines low tidal volume and appropriate PEEP levels to minimize barotrauma and volutrauma. Prone positioning can be beneficial in ARDS patients by improving oxygenation and reducing ventilator-induced lung injury. Allowing for higher levels of carbon dioxide (permissive hypercapnia) may be necessary to avoid excessive ventilator pressures.  Continuous monitoring of oxygenation, ventilation, and lung mechanics is essential to adjust ventilatory settings as needed. Individualized PEEP selection using techniques like the recruitment-to-inflation (R/I) ratio helps tailor ventilatory support to each patient's needs.

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Dr. Rishabh Kumar Mittal
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Dr. Rishabh Kumar Mittal

Principal Consultant Critical Care Medicine and Incharge Gastro Liver & Liver Transplant ICU Max Superspeciality Hospital, Delhi

Dr Rishabh Kumar Mittal is a well known intensive care physician having more than 12 years of experience in the field of Critical Care Medicine. After completing his post graduation from prestigious S.M.S Medical College and attached group hospitals , Jaipur; he ventured in the field of Critical Care Medicine and completed F.N.B in Critical Care Medicine from Fortis Escorts Heart Institute, New Delhi. He is an astute clinician and academician and is a teacher & guide for DrNB,F.N.B, IDCCM, IFCCM and IDCCN courses in Critical Care Medicine.

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Ventilatory strategies in Acute Respiratory Distress Syndrome (ARDS) are crucial for optimizing oxygenation and minimizing further lung injury. Ventilating with low tidal volumes (6 mL/kg of predicted body weight or lower) reduces the risk of ventilator-induced lung injury (VILI).  PEEP is used to maintain alveolar recruitment and improve oxygenation while preventing lung collapse during expiration.  A lung-protective ventilation strategy combines low tidal volume and appropriate PEEP levels to minimize barotrauma and volutrauma. Prone positioning can be beneficial in ARDS patients by improving oxygenation and reducing ventilator-induced lung injury. Allowing for higher levels of carbon dioxide (permissive hypercapnia) may be necessary to avoid excessive ventilator pressures.  Continuous monitoring of oxygenation, ventilation, and lung mechanics is essential to adjust ventilatory settings as needed. Individualized PEEP selection using techniques like the recruitment-to-inflation (R/I) ratio helps tailor ventilatory support to each patient's needs.