Bilevel positive airway pressure-airway pressure release ventilation dans le syndrome de détresse respiratoire aiguë de l'adulte : physiopathologie, domaine d'application

The prognosis of Acute Respiratory Distress Syndrome is taking a turn for the better since these two last decades. Tidal volume reduction to limit plateau pressure and individual PEEP titration could be considered as the key points of this upward trend as regards mortality. The price to pay of such ventilatory strategy is mainly due to sedation's adverse effects. Recent physiological data suggest that the use of a ventilatory mode allowing spontaneous breathing may be beneficial. In fact, a protocol aiming at reducing sedation and paralysis requirement has been shown to reduce duration of mechanical ventilation. Moreover, spontaneous ventilation may limit diaphragmatic dysfunction and contributes to recruit the dependent lungs regions thus improving gas exchanges. In this aim, Bilevel Positive Airway Pressure - Airway Pressure Release Ventilation is of potential interest since it allows spontaneous breathing on two level of continue positive pressure thus limiting side effects due to over sedation.