Overview: Acute respiratory distress syndrome (ARDS) is a serious life-threatening lung reaction to several forms of injuries that cause hypoxia. It is characterized by diffuse pulmonary inflammation, hypoxemia, and respiratory distress. It has been established that mechanical ventilation by lung protection strategy can be provided in patients with ARDS. This can result in better pulmonary function and higher rates of weaning from the ventilator. A lung-protective strategy should be applied to patients with ARDS who are on a mechanical ventilator. Brief of the case study: A 48-year-old obese patient was admitted to the intensive care unit (ICU) with extreme breathlessness and severe abdominal pain. Laboratory investigations: Lipase – 5000 U/L White blood cell count – 18000 / ml SGPT – 1000 U/L LDH – 1000 U/L SpO2 – 86% Diagnosis: Severe acute pancreatitis Treatment given: A rapid sequence intubation was done, and the patient was ventilated with a lung-protective ventilation strategy. A decision to intubate and ventilate the patient was taken due to type 1 respiratory distress. Discussion: ARDS patients have poor lung compliance as the proportion of lungs available for ventilation is markedly reduced. Therefore, normalizing the tidal volume to the lower respiratory system compliance could indicate the functional size of the lung, and this index (TV/CRS) is called the driving pressure or delta P. 1 The strategy of lung-protective ventilation involves low tidal volume ventilation, higher levels of PEEP, and low plateau pressures. Certain studies have concluded that the decrease of this “delta P” or the driving pressure was responsible for the increased survival. This delta P can be calculated by subtracting PEEP from the plateau pressure in patients who are not having an inspiratory effort.1 Reference:  Amato et al. Driving pressure and survival in acute respiratory distress syndrome. NEJM. 2015; 372:747-55. 241

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