Techniques of ventilatory therapy in the adult respiratory distress syndrome (ARDS).

Techniques of respiratory support in ARDS are becoming more and more complex. New modes of ventilatory therapy like continuous positive airway pressure (CPAP), appeared during the last years and became popular; other ones are now under investigation, high frequency ventilation and extracorporeal CO2 removal, for instance. A lot of abbreviations are actually commonly used by physicians involved in intensive care as well as by ventilator industries. The purpose of this article is to review these different modes of respiratory assistance in ARDS, as well as their indications. They are grouped into four categories: mechanical ventilation, spontaneous breathing with positive pressure, a "mature" of both, also called intermittent mandatory ventilation (IMV) and finally extracorporeal support. The respective use of these different modes in our Center of Intensive Care at the University of Liège during recent years is analysed. It appears that mechanical ventilation, especially with positive end expiratory pressure (PEEP) keeps a place of choice and that spontaneous breathing with positive pressure (CPAP) represents one of the best improvements of the late years in respiratory intensive care. Last but not least is the absolute necessity to start respiratory assistance with positive pressure as soon as possible, once the diagnosis of ARDS is suspected.