CrossTalk opposing view: There is not added benefit to providing permissive hypercapnia in the treatment of ARDS

摘要

Current ventilator strategies for acute respiratory distress syndrome (ARDS) aim to impact lung function and clinical outcomes in several ways: low tidal volumes to minimize overdistension, titrated positive end-expiratory pressure (PEEP) to prevent alveolar derecruitment, and recruitment manoeuvres to promote parenchymal homogeneity. Among these interventions, only low tidal volume has been shown definitively to improve mortality from ARDS (Malhotra, 2007). During low tidal volume ventilation, practice varies substantially on whether to allow some degree of alveolar hypo-ventilation with incidental hypercapnic acidosis (Amato et al. 1998), or to increase respiratory rate to maintain alveolar ventilation, often requiring respiratory rates >30 breaths min"1 (Brower et al. 2000).