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Volume 357:2518-2520 December 13, 2007 Number 24
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Low-Tidal-Volume Ventilation

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by Malhotra, A.
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To the Editor: In his important review of low-tidal-volume ventilation in the acute respiratory distress syndrome (ARDS) (Sept. 13 issue),1 Dr. Malhotra reports that the strategy is a fundamental advance in the management of ARDS. However, he does not describe certain adjuvant or alternative strategies to provide sufficient oxygenation while avoiding deleterious plateau pressures. First, the use of inhaled nitric oxide, almitrine mesylate, or both has been shown to produce spectacular results in terms of the partial pressure of arterial oxygen (PaO2) and pulmonary-shunt reduction in "responders."2 Second, early use of neuromuscular blocking agents in association with classic sedative . . . [Full Text of this Article]



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