Permissive Hyperkapnie und Bauchlage – Therapiestrategien des ARDS

TLDR: Controlled mechanical hypoventilation with reduced tidal volumes and peak inspiratory pressures has been introduced into the treatment of ARDS in order to avoid pulmonary hyperinflation and ventilator-induced lung injury.

Abstract: Controlled mechanical hypoventilation with reduced tidal volumes and peak inspiratory pressures has been introduced into the treatment of ARDS in order to avoid pulmonary hyperinflation and ventilator-induced lung injury. The concomitant increase of arterial PCO2 has been denoted as permissive hypercapnia. Recent clinical studies suggest a potential benefit of this concept for patients with acute respiratory failure, although several organ systems can be affected by the increase of PaCO2. The impaired pulmonary gas exchange in ARDS can be effectively improved by patients with positioning acute respiratory failure prone. A redistribution of pulmonary blood flow has been suggested earlier to account for this observation. However, recent data from animal studies showed a decrease of the vertical pleura pressure gradient, which could facilitate reopening and ventilation of previously atelectatic lung segments.