Ventilatory strategies in the management of the adult respiratory distress syndrome.

This article review available strategies for mechanically ventilating patients with the adult respiratory distress syndrome. The authors first present the conventional strategies of mechanical ventilation: volume-limited mechanical ventilation with positive end-expiratory pressure (PEEP) at normal inspiratory-expiratory ratios, the approach that has been the mainstay of ventilatory support since the initial description of PEEP. This discussion attempts to summarize the rationale and goals of treatment in a practical, clinically useful manner. The second section of the article reviews less conventional ventilatory approaches, including inverse ratio ventilation, extracorporeal techniques, high-frequency ventilation, prone position, and fluctuating PEEP, and attempts to review critically the available literature regarding their application.