Early application of the lung protective ventilation strategy at different stages in two ARDS patients

We experienced 2 patients with acute respiratory distress syndrome (ARDS) from pneumonia after intervention for subarachnoidal hemorrhage. We applied lung protective ventilation strategy (LPVS) on both cases: a tidal volume less than 6 ml x kg(-1) ideal body weight and PEEP at 10-15 cmH2O. Although etiology and degree of hypoxia were very similar in two patients when ARDS was diagnosed, clinical course was quite different. The patient in whom LPVS had been started on the 5th day of ARDS required mechanical ventilation of 23 days. In contrast, another patient in whom LPVS had been started on the 16th day of ARDS required mechanical ventilation of 219 days. PaCO2 during LPVS with permissive hypercapnia in the latter patient increased up to 161 mmHg but no adverse effect was observed. These cases suggest that early application of the LPVS may be important to improve respiratory outcomes of ARDS patients.