ICU SAQs · ARDS & lung protection
Respiratory mechanics and the 'baby lung' in ARDS
A CICM First-Part basic-science question on the respiratory mechanics of ARDS — the regional heterogeneity of the injured lung, the 'baby lung' concept, why predicted (not actual) body weight governs tidal volume, and how the driving pressure became the real-time index of strain. Tests applied physiology rather than management.
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Prompt
Explain the regional physiology of the ARDS lung (the 'baby lung'), and use it to justify why tidal volume is set on predicted body weight and titrated against the driving pressure. Support your answer with the relevant experimental and clinical evidence.
Question
Explain the regional physiology of the ARDS lung (the "baby lung"), and use it to justify why tidal volume is set on predicted body weight and titrated against the driving pressure. Support your answer with the relevant experimental and clinical evidence.
[2]References5ShowHide
- [1]Gattinoni L, et al. Regional Physiology of ARDS. Critical Care, 2017.PMID 29297365
- [2]Dreyfuss D, et al. High Inflation Pressure Pulmonary Edema. Respective Effects of High Airway Pressure, High Tidal Volume, and Positive End-Expiratory Pressure. American Review of Respiratory Disease, 1988.PMID 3057957
- [3]Amato MBP, et al. Driving Pressure and Survival in the Acute Respiratory Distress Syndrome. New England Journal of Medicine, 2015.PMID 25693014
- [4]Brower RG, Matthay MA, Morris A, et al. Ventilation with Lower Tidal Volumes as Compared with Traditional Tidal Volumes for Acute Lung Injury and the Acute Respiratory Distress Syndrome. New England Journal of Medicine, 2000.PMID 10793162
- [5]Bersten AD, Soni N (eds). Oh's Intensive Care Manual. 8th edition, Elsevier, 2018.