What is the primary respiratory support for acute respiratory distress syndrome (ARDS)?

What is the primary respiratory support for acute respiratory distress syndrome (ARDS)?

• A. Positive pressure ventilation via endotracheal intubation or BiPAP
• B. Noninvasive ventilation only
• C. Inhaled nitric oxide only
• D. Supplemental oxygen via nasal cannula only

Answer: (A)

In ARDS the lungs are flooded and stiff, leading to severe hypoxemia that often won’t improve with oxygen alone. The key idea is that you must mechanically recruit and keep the alveoli open to improve gas exchange and reduce the work of breathing. Positive pressure ventilation achieves that by delivering air under pressure, which expands collapsed units and maintains them with PEEP. This approach can be given invasively through endotracheal intubation or noninvasively with devices like BiPAP, depending on the patient’s condition and ability to protect the airway. Delivering positive pressure, with a lung-protective strategy (low tidal volumes and appropriate PEEP), is the foundation of ARDS management because it directly addresses the mechanical failure driving hypoxemia. Supplemental oxygen alone cannot correct the problem of collapsed and nonuniform lungs, and inhaled nitric oxide is an adjunct for specific cases of refractory hypoxemia rather than the primary method of support. Noninvasive ventilation may be attempted in select, less severe cases, but the overarching, reliable management relies on positive pressure ventilation to ensure adequate oxygenation and ventilation.

In ARDS the lungs are flooded and stiff, leading to severe hypoxemia that often won’t improve with oxygen alone. The key idea is that you must mechanically recruit and keep the alveoli open to improve gas exchange and reduce the work of breathing. Positive pressure ventilation achieves that by delivering air under pressure, which expands collapsed units and maintains them with PEEP. This approach can be given invasively through endotracheal intubation or noninvasively with devices like BiPAP, depending on the patient’s condition and ability to protect the airway.

Delivering positive pressure, with a lung-protective strategy (low tidal volumes and appropriate PEEP), is the foundation of ARDS management because it directly addresses the mechanical failure driving hypoxemia. Supplemental oxygen alone cannot correct the problem of collapsed and nonuniform lungs, and inhaled nitric oxide is an adjunct for specific cases of refractory hypoxemia rather than the primary method of support. Noninvasive ventilation may be attempted in select, less severe cases, but the overarching, reliable management relies on positive pressure ventilation to ensure adequate oxygenation and ventilation.