Acute respiratory failure: From intubation to ECMO

Introduction: Acute severe respiratory failure poses a major treatment challenge which stubbornly carries high mortality and morbidity rates. Here, we review PaO2/FiO2 (PF) ratio and disease severity, and discuss protective lung ventilation and the rescue therapies, and when to use what? PF ratio alone is not sufficient to determine disease severity: A recent study by Villar and colleagues demonstrated that only 38% of patients who were classified as severe acute respiratory disease syndrome (ARDS) patients based on the PF ratio met the actual severe ARDS criteria after a standardized ventilator setting. In a recent trial conducted by Caironi 1 and colleagues, alteration in the positive end-expiratory pressure (PEEP) level affected the PF ratio and disease severity. Using the PF ratio alone as the major determinant for disease severity will increase the risk of selecting the wrong therapy for the patient. Protective lung ventilation: Between 1998 and 2000, two prospective randomized controlled trials (RCT...