Critical Care Medicine

Answer 5 Inhaled NO, prone positioning, and high- frequency oscillatory ventilation have been shown to improve oxygenation but not mortality.9 No pharmacologic therapy has been shown to improve mortality for patients with ARDS. Recombinant surfactant, while extremely successful in treating respiratory distress of the newborn, has not been shown to decrease mortality or number of days on the ventilator in adults with ARDS. Inhaled NO, a rapidly inactivated vasodilator, improves oxygenation more rapidly than placebo but does not improve mortality or duration of ventilatory support. Likewise, prone positioning improves oxygenation but has not translated into improved mortality. The prone position may increase pressure sores in unusual areas (eg, cheek, breast, iliac crest) and may increase the potential for retinal ischemia, but the procedure is safe when these sites are monitored vigilantly. High- frequency oscillatory ventilation (HFOV) is a ventilatory strategy whereby the lung is oscillated at a set airway pressure with minimal deflation of the lungs. Thus, HFOV uses an almost unmeasurably low tidal volume, avoiding overdistension. HFOV is safe, has a comparable mortality to conventional treatment of ARDS, and appears to improve oxygenation compared with conventional ventilation. To date, HFOV has not been shown to improve mortality. REFERENCES 9. Brower RG, Ware LB, Berthiaume Y, Matthay MA. Treatment of ARDS. Chest 2001;120:1347-67. Click here to return to the questions

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