15 – What Is the Best Mechanical Ventilation Strategy in ARDS?

Abstract: Mechanical ventilation is a central component of the management of patients with acute respiratory distress syndrome (ARDS). However, if it is used improperly, it can lead to further lung injury and worsen clinical outcomes. In this chapter, we present the clinical evidence for lung-protective and open lung ventilation, driving pressure, modes of ventilation, neuromuscular blockade, and prone positioning. We frame our discussion around when and how these strategies can improve outcomes by considering the mechanisms by which they might mitigate ventilator-induced lung injury.