Spontaneous Versus Controlled Mechanical Ventilation in Patients with Acute Respiratory Distress Syndrome

doi:10.1007/s40140-021-00443-8

Review

. 2021;11(2):85-91.

doi: 10.1007/s40140-021-00443-8. Epub 2021 Mar 3.

Spontaneous Versus Controlled Mechanical Ventilation in Patients with Acute Respiratory Distress Syndrome

Tayyba Naz Aslam^{1

2}, Thomas Lass Klitgaard^{3

4}, Kristin Hofsø^{2

5}, Bodil Steen Rasmussen^{3

4}, Jon Henrik Laake^{1

2}

Affiliations

¹ Department of Anaesthesiology, Division of Emergencies and Critical Care, Rikshospitalet Medical Centre, Oslo University Hospital, P.O.Box 4950, Nydalen, Oslo, Norway.
² Department of Research and Development, Division of Emergencies and Critical Care, Oslo University Hospital, Oslo, Norway.
³ Department of Anaesthesia and Intensive Care Medicine, Aalborg University Hospital, Aalborg, Denmark.
⁴ Department of Clinical Medicine, Aalborg University, Aalborg, Denmark.
⁵ Lovisenberg Diaconal University College, Oslo, Norway.

PMID: 33679255
PMCID: PMC7925253
DOI: 10.1007/s40140-021-00443-8

Review

Spontaneous Versus Controlled Mechanical Ventilation in Patients with Acute Respiratory Distress Syndrome

Tayyba Naz Aslam et al. Curr Anesthesiol Rep. 2021.

. 2021;11(2):85-91.

doi: 10.1007/s40140-021-00443-8. Epub 2021 Mar 3.

Authors

Tayyba Naz Aslam^{1

2}, Thomas Lass Klitgaard^{3

4}, Kristin Hofsø^{2

5}, Bodil Steen Rasmussen^{3

4}, Jon Henrik Laake^{1

2}

Affiliations

¹ Department of Anaesthesiology, Division of Emergencies and Critical Care, Rikshospitalet Medical Centre, Oslo University Hospital, P.O.Box 4950, Nydalen, Oslo, Norway.
² Department of Research and Development, Division of Emergencies and Critical Care, Oslo University Hospital, Oslo, Norway.
³ Department of Anaesthesia and Intensive Care Medicine, Aalborg University Hospital, Aalborg, Denmark.
⁴ Department of Clinical Medicine, Aalborg University, Aalborg, Denmark.
⁵ Lovisenberg Diaconal University College, Oslo, Norway.

PMID: 33679255
PMCID: PMC7925253
DOI: 10.1007/s40140-021-00443-8

Abstract

Purpose of review: To review clinical evidence on whether or not to allow mechanically ventilated patients with acute respiratory distress syndrome (ARDS) to breathe spontaneously.

Recent findings: Observational data (LUNG SAFE study) indicate that mechanical ventilation allowing for spontaneous breathing (SB) is associated with more ventilator-free days and a shorter stay in the intensive care unit without any effect on hospital mortality. A paediatric trial, comparing airway pressure release ventilation (APRV) and low-tidal volume ventilation, showed an increase in mortality in the APRV group. Conversely, in an unpublished trial comparing SB and controlled ventilation (NCT01862016), the authors concluded that SB is feasible but did not improve outcomes in ARDS patients.

Summary: A paucity of clinical trial data continues to prevent firm guidance on if or when to allow SB during mechanical ventilation in patients with ARDS. No published large randomised controlled trial exists to inform practice about the benefits and harms of either mode.

Keywords: ALI; ARDS; Acute lung injury; Acute respiratory distress syndrome; Mechanical ventilation; Spontaneous ventilation.

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Conflict of interest statement

Conflict of InterestNone of the authors has any potential conflicts of interest to disclose

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References

1. Ranieri VM, Rubenfeld GD, Thompson BT, Ferguson ND, Caldwell E, Fan E, et al. Acute respiratory distress syndrome: the Berlin Definition. JAMA. 2012;307(23):2526–2533. doi: 10.1001/jama.2012.5669. - DOI - PubMed
1. Bellani G, Laffey JG, Pham T, Fan E, Brochard L, Esteban A, et al. Epidemiology, patterns of care, and mortality for patients with acute respiratory distress syndrome in intensive care units in 50 Countries. JAMA. 2016;315(8):788–800. doi: 10.1001/jama.2016.0291. - DOI - PubMed
1. Laffey JG, Pham T, Bellani G. Continued under-recognition of acute respiratory distress syndrome after the Berlin definition: what is the solution? Curr Opin Crit Care. 2017;23(1):10–17. doi: 10.1097/mcc.0000000000000381. - DOI - PubMed
1. Brown SM, Wilson EL, Presson AP, Dinglas VD, Greene T, Hopkins RO, et al. Understanding patient outcomes after acute respiratory distress syndrome: identifying subtypes of physical, cognitive and mental health outcomes. Thorax. 2017;72(12):1094–1103. doi: 10.1136/thoraxjnl-2017-210337. - DOI - PMC - PubMed
1. Fan E, Brodie D, Slutsky AS. Acute respiratory distress syndrome: advances in diagnosis and treatment. Jama. 2018;319(7):698–710. doi: 10.1001/jama.2017.21907. - DOI - PubMed

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[1] Ranieri VM, Rubenfeld GD, Thompson BT, Ferguson ND, Caldwell E, Fan E, et al. Acute respiratory distress syndrome: the Berlin Definition. JAMA. 2012;307(23):2526–2533. doi: 10.1001/jama.2012.5669. - DOI - PubMed

[2] Ranieri VM, Rubenfeld GD, Thompson BT, Ferguson ND, Caldwell E, Fan E, et al. Acute respiratory distress syndrome: the Berlin Definition. JAMA. 2012;307(23):2526–2533. doi: 10.1001/jama.2012.5669. - DOI - PubMed

[3] Bellani G, Laffey JG, Pham T, Fan E, Brochard L, Esteban A, et al. Epidemiology, patterns of care, and mortality for patients with acute respiratory distress syndrome in intensive care units in 50 Countries. JAMA. 2016;315(8):788–800. doi: 10.1001/jama.2016.0291. - DOI - PubMed

[4] Bellani G, Laffey JG, Pham T, Fan E, Brochard L, Esteban A, et al. Epidemiology, patterns of care, and mortality for patients with acute respiratory distress syndrome in intensive care units in 50 Countries. JAMA. 2016;315(8):788–800. doi: 10.1001/jama.2016.0291. - DOI - PubMed

[5] Laffey JG, Pham T, Bellani G. Continued under-recognition of acute respiratory distress syndrome after the Berlin definition: what is the solution? Curr Opin Crit Care. 2017;23(1):10–17. doi: 10.1097/mcc.0000000000000381. - DOI - PubMed

[6] Laffey JG, Pham T, Bellani G. Continued under-recognition of acute respiratory distress syndrome after the Berlin definition: what is the solution? Curr Opin Crit Care. 2017;23(1):10–17. doi: 10.1097/mcc.0000000000000381. - DOI - PubMed

[7] Brown SM, Wilson EL, Presson AP, Dinglas VD, Greene T, Hopkins RO, et al. Understanding patient outcomes after acute respiratory distress syndrome: identifying subtypes of physical, cognitive and mental health outcomes. Thorax. 2017;72(12):1094–1103. doi: 10.1136/thoraxjnl-2017-210337. - DOI - PMC - PubMed

[8] Brown SM, Wilson EL, Presson AP, Dinglas VD, Greene T, Hopkins RO, et al. Understanding patient outcomes after acute respiratory distress syndrome: identifying subtypes of physical, cognitive and mental health outcomes. Thorax. 2017;72(12):1094–1103. doi: 10.1136/thoraxjnl-2017-210337. - DOI - PMC - PubMed

[9] Fan E, Brodie D, Slutsky AS. Acute respiratory distress syndrome: advances in diagnosis and treatment. Jama. 2018;319(7):698–710. doi: 10.1001/jama.2017.21907. - DOI - PubMed

[10] Fan E, Brodie D, Slutsky AS. Acute respiratory distress syndrome: advances in diagnosis and treatment. Jama. 2018;319(7):698–710. doi: 10.1001/jama.2017.21907. - DOI - PubMed

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Spontaneous Versus Controlled Mechanical Ventilation in Patients with Acute Respiratory Distress Syndrome

Affiliations

Spontaneous Versus Controlled Mechanical Ventilation in Patients with Acute Respiratory Distress Syndrome

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