Clinical Guidelines: ARDS Ventilation Practices Analysis

This report provides a concise overview of the clinical practice guidelines for managing patients with Acute Respiratory Distress Syndrome (ARDS) through mechanical ventilation. It discusses common adverse consequences of ARDS, including inflammation-induced pulmonary capillary leakage, bilateral opacities, and hypoxemia. The report emphasizes the importance of mitigating ventilator-associated lung injury (VALI) through strategies like prone positioning and optimal positive end-expiratory pressure (PEEP) values. It highlights the American Thoracic Society and European Society of Intensive Care Medicine's recommendations for low tidal volumes and lower inspiratory pressures, while also acknowledging the consensus on high PEEP and oscillatory ventilation for severe ARDS cases. The paper concludes by underscoring the need for globally accepted ventilation guidelines to ensure patient care aligns with ethical principles.

Running head: ACUTE RESIPIRATORY DISTRESS SYNDROME
ACUTE RESPIRATORY DISTRESS SYNDROME
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1ACUTE RESPIRATORY DISTRESS SYNDROME
Introduction
The following paper will briefly discuss on clinical practice guidelines associated with
best ventilation practices to be used across patients with ARDS.
Discussion
Common adverse consequences associated with the ARDS include: diffused leakage
across pulmonary capillaries as a result of inflammation, radiographic observations of pulmonary
bilateral opacities and acute incidence of the onset of hypoxemia (PaO2/FiO2 equal to, or lesser
than 300). A key contributor of such adverse effects is ventilator associated lung injury (VALI)
which results in excessive distension of the regional alveolar walls resulting in volutrauma,
barotrauma and atelectrauma, or the opening and collapse of tidal volumes (Del Sorbo, Hubmayr
& Slutsky, 2019).
Prone positioning, along with higher values of positive end expiratory pressures (PEEP),
have been evidenced by Del Sorbo et al., (2019), to be effective in the mitigation of VALI and
mortality risk in ARDS patients. There continues to be clinical speculation however, concerning
optimal or standardized values of PEEP and tidal volumes to be maintained for VALI reduction.
The American Thoracic Society and European Society of Intensive Care Medicine, are
collaborative in support of the deliverance of low tidal volume values (4 to 8ml/per kg of body
weight predicted), and lower rates of inspiratory volume pressures (less than 30cm H20 of
plateau pressure) as best practice ventilation guidelines for all patients with ARDS. For patients
with severe ARDS, there is a collective consensus in support of high PEEP and high frequencies
of oscillatory ventilation (Fan et al., 2017). Thus, considering the range of evidence, there is a
need to establish globally acceptable optimal ventilation guidelines in order to ensure adherence

2ACUTE RESPIRATORY DISTRESS SYNDROME
to the biblical principle of protecting an individual’s right to light and dignity (Waters, Schmale,
Goetz, Eberl & Wells, 2017).
Conclusion
This paper, thus, successfully discusses on the available evidence concerning best
ventilation guidelines which may be administered for mitigating mortality and symptoms in
ARDS patients.

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References
Del Sorbo, L., Hubmayr, R., & Slutsky, A. S. (2019). Mechanical Ventilation in Acute
Respiratory Distress SyndromeTime Heals All Wounds, or Does It?. Anesthesiology: The
Journal of the American Society of Anesthesiologists, 130(5), 680-682. doi:
https://doi.org/10.1097/ALN.0000000000002671
Fan, E., Del Sorbo, L., Goligher, E. C., Hodgson, C. L., Munshi, L., Walkey, A. J., ... &
Ferguson, N. D. (2017). An official American Thoracic Society/European Society of
Intensive Care Medicine/Society of Critical Care Medicine clinical practice guideline:
mechanical ventilation in adult patients with acute respiratory distress
syndrome. American journal of respiratory and critical care medicine, 195(9), 1253-
1263. doi: http://dx.doi.org/10.1164/rccm.201703-0548ST.
Waters, N. P., Schmale, T., Goetz, A., Eberl, J. T., & Wells, J. H. (2017). A call to promote
healthcare justice: A summary of integrated outpatient clinics exemplifying principles of
Catholic social teaching. The Linacre Quarterly, 84(1), 57-73. doi:
https://doi.org/10.1080/00243639.2016.1272330.