SCCM Resource Library-Pro/Con Debate: Should We Allow Spontaneous Breathing in ARDS?

Video Transcription

Video Summary

In this video, two speakers discuss whether or not spontaneous breathing should be allowed in acute respiratory distress syndrome (ARDS) patients. The first speaker argues that spontaneous breathing should be allowed, as it can help reduce the work of breathing, relieve discomfort, and improve gas exchange. They also point out that allowing spontaneous breathing better matches ventilation to perfusion and can improve distribution of regional strains in the lungs. The speaker acknowledges that sustained dyspnea, pain, or agitation should not be tolerated and that patient comfort should be a priority. The second speaker takes a more cautious stance, suggesting that spontaneous breathing may not be ideal in severe ARDS cases. They argue that spontaneous breathing can lead to high transpulmonary pressures, potentially causing lung injury. The speaker suggests that in mild to moderate ARDS, spontaneous breathing is likely beneficial, but in severe cases, it may be best to limit or control spontaneous efforts. The speakers also discuss factors such as patient comfort, sedation, and paralysis in the context of allowing spontaneous breathing. They emphasize the importance of individualized care and monitoring the patient's condition closely to determine the best approach.

Asset Subtitle

Pulmonary, Procedures, 2020

Asset Caption

The Society of Critical Care Medicine's Critical Care Congress features internationally renowned faculty and content sessions highlighting the most up-to-date, evidence-based developments in critical care medicine. This is a presentation from the 2020 Critical Care Congress held February 16-19, 2020, in Orlando, Florida, USA.

Learning Objectives

Analyze the pros and cons of spontaneous breathing during acute respiratory distress syndrome (ARDS)
Decide when and when not to allow spontaneous breathing during ARDS
Recognize the importance of spontaneous breathing to prevent ventilator-associated diaphragm dysfunction and muscle wasting
Discuss the phenomenon of pendelluft in regional overdistention and contribution to ventilator-associated lung injury in ARDS
Assess early versus late prevention or allowance of spontaneous breathing in ARDS

Spontaneous Breathing in ARDS: Absolutely

John J. Marini

Spontaneous Breathing in ARDS: Absolutely Not . . . or Does It Depend?

Ulrich Schmidt

Meta Tag

Content Type Presentation

Knowledge Area Pulmonary

Knowledge Area Procedures

Knowledge Level Intermediate

Knowledge Level Advanced

Membership Level Select

Membership Level Professional

Membership Level Associate

Tag Acute Respiratory Distress Syndrome ARDS

Tag Ventilation

Tag Cardiothoracic Critical Care

Year 2020

Keywords

spontaneous breathing

acute respiratory distress syndrome

ARDS

work of breathing

gas exchange

ventilation to perfusion

patient comfort

severe ARDS

lung injury

individualized care

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