What role do non-invasive ventilation and mechanical ventilation play in the management of ARDS?

Non-invasive ventilation (NIV) in the management of acute respiratory distress syndrome (ARDS) provides respiratory support without the need for an endotracheal tube or tracheostomy, which can reduce complications associated with invasive ventilation such as ventilator-associated pneumonia and airway trauma.

NIV is typically considered in patients with less severe respiratory failure or as a step before invasive mechanical ventilation, but its use requires careful patient selection and monitoring due to the risk of NIV failure and the need for escalation to invasive ventilation if respiratory status worsens.

Mechanical ventilation is the mainstay of respiratory support in moderate to severe ARDS, where invasive ventilation via an endotracheal tube is used to ensure adequate oxygenation and ventilation.

Volume-targeted ventilation (VTV) combined with synchronized ventilation modes is preferred to optimize tidal volumes and reduce ventilator-induced lung injury.

If VTV is ineffective, high-frequency oscillatory ventilation (HFOV) may be considered as an alternative invasive ventilation strategy.

Non-synchronised or pressure-limited ventilation modes such as assist control or pressure support ventilation are generally not recommended due to less favorable outcomes.

Overall, the role of NIV is limited and supportive in ARDS, while invasive mechanical ventilation with lung-protective strategies remains the cornerstone of management.

This approach aims to minimize lung injury while ensuring adequate gas exchange in critically ill patients with ARDS.