New Respiratory and Hemodynamic Strategies of the Revised Berlin Definitions of the Acute Respiratory Distress Syndrome
This article presents an overview and analysis of the new respiratory and hemodynamic strategies of the revised Berlin definitions of the acute respiratory distress syndrome (ARDS) on the basis of the researches published from 2011 to present: re-structured definition of acute respiratory distress syndrome; inclusion in the diagnostic criteria for the management of regression of noninvasive surrogate SF indicator; characteristics of the structural changes in the lungs in mechanical ventilation (MV); the introduction of the term «respiratory lungs»; criteria of the feasibility of including «respiratory lungs» tactics; predictors of noninvasive MV failure; assessment of the lung recruitability; statement that ultraprotective strategy for MV with low-flow CO2 improves clinical outcomes in patients with moderate ARDS; the correlation between the time of intubation and the percentage of mortality; evaluating the effectiveness of conservative and liberal oxygenation strategy; multivariate analysis of the relationship of conservative and liberal versions of infusion therapy for ARDS, the initial central venous pressure and disease outcome; feasibility of using isolated veno-venous or veno-arterial extracorporeal membrane oxygenation in ARDS and refractory septic shock, and determining the advantages of VVA-modification; description of Lung Injury Prediction Score; methods of ARDS prevention in high risk patients.