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Acute respiratory distress syndrome is usually treated with mechanical ventilation in the intensive care unit (ICU). Mechanical ventilation is usually delivered through a rigid tube which enters the oral cavity and is secured in the airway (endotracheal intubation), or by tracheostomy when prolonged ventilation (≥2 weeks) is necessary. The role of non-invasive ventilation is limited to the very early period of the disease or to prevent worsening respiratory distress in individuals with atypical pneumonias , lung bruising , or major surgery patients, who are at risk of developing ARDS. Treatment of the underlying cause is crucial. Appropriate antibiotic therapy must be administered as soon as microbiological culture results are available, or clinical infection is suspected (whichever is earlier). Empirical therapy may be appropriate if local microbiological surveillance is efficient. The origin of infection, when surgically treatable, must be removed. When sepsis is diagnosed, appropriate local protocols should be enacted.

My Mom is a C02 retainer. We have been to the ER often where a bipap has been used very successfully to get her C02 back to her normal level and she has returned home back to normal. She recently had another incident (very lathargic and disoriented) and she went to a different hospital. The ER doc insisted on putting her on a ventilator. I am wondering if this was necessay. It has been 2 days and she is still on the ventilator. She is very alert, writing us notes and understanding everything that is going on. She is 80 and not ambulatory. I am concerned. They’ve tried 4 times (the spontaneous trials noted above) but she has not been able to breathe on her own. Any advice would be most appreciative. The ICU nurses have been wonderful. I would love some guidance from an external physician.

1.     Cavalcanti AB, Suzumura A, Laranjeira LN et al. Effect of Lung Recruitment and Titrated Positive End-Expiratory Pressure (PEEP) vs Low PEEP on Mortality in Patients With Acute Respiratory Distress Syndrome JAMA. 2017; 318(14):1335-.
2.     Ventilation with Lower Tidal Volumes as Compared with Traditional Tidal Volumes for Acute Lung Injury and the Acute Respiratory Distress Syndrome N Engl J Med. 2000; 342(18):1301-1308.
3.     Kacmarek RM, Villar J, Sulemanji D et al. Open Lung Approach for the Acute Respiratory Distress Syndrome Critical Care Medicine. 2016; 44(1):32-42.
4.     Damiani LP, Berwanger O, Paisani D et al. Statistical analysis plan for the Alveolar Recruitment for Acute Respiratory Distress Syndrome Trial (ART). A randomized controlled trial . 2017; 29(2).
5.     The ART Investigators. Rationale, study design, and analysis plan of the Alveolar Recruitment for ARDS Trial (ART): Study protocol for a randomized controlled trial Trials. 2012; 13(1).

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