CARING FOR THE CRITICALLY ILL PATIENT Ventilation Strategy Using Low Tidal Volumes, Recruitment Maneuvers, and High Positive End-Expiratory Pressure for Acute Lung Injury and Acute Respiratory Distress Syndrome A Randomized Controlled Trial

ACUTE LUNG INJURY AND ACUTE respiratory distress syndrome (ARDS, the most severe form of acute lung injury), are potentially devastating complications of critical illness. Arising in response to direct lung injury (eg, pneumonia) or intense systemic inflammation (eg, sepsis), the pathogenesis involves pulmonary edema, diffuse cellular destruction, alveolar collapse, and disordered repair. Mortality and health care costs are high, and long-term survivors experience serious morbidity. See also pp 646, 691, and 693. Author Affiliations: are listed at the end of this article. CorrespondingAuthor:MaureenO.Meade,MD,MSc, DepartmentsofMedicineandEpidemiologyandBiostatistics,McMasterUniversity,1200MainStW,Room210C, Hamilton, ON L8N 3Z5, Canada ([email protected]). Context Low-tidal-volume ventilation reduces mortality in critically ill patients with acute lung injury and acute respiratory distress syndrome. Instituting additional strategies to open collapsed lung tissue may further reduce mortality.