Ten golden rules to individualize mechanical ventilation in acute respiratory distress syndrome

Over the last decades, great strides have been made in the management of acute respiratory distress syndrome (ARDS) Mechanical ventilation remains the cornerstone of supportive therapy for ARDS Lung-protective mechanical ventilation minimizes the risk of ventilator-induced lung injury (VILI) and improves survival Several parameters are determinants of VILI and require careful setting, such as tidal volume (VT), plateau pressure (Pplat), driving pressure (DP), positive end-expiratory pressure (PEEP), and respiratory rate Furthermore, measurement of energy and mechanical power may enable quantification of the relative contribution of its different components (VT, Pplat, ΔP, PEEP, respiratory rate, and airflow) and better individualize mechanical ventilation settings The use of neuromuscular blocking agents is of interest, mainly in cases of severe ARDS, to improve oxygenation and reduce asynchrony;however, no significant changes in survival have been observed Rescue respiratory therapies, such as prone positioning, inhaled nitric oxide, and extracorporeal support techniques may also be used in specific situations Furthermore, respiratory weaning protocols should be discussed After reviewing all recent clinical trials, we now present 10 golden rules to individualize mechanical ventilation in ARDS management