Adjunctive Therapy to Mechanical Ventilation: Surfactant Therapy, Liquid Ventilation, and Prone Position

ALI and ARDS are associated with significant morbidity and mortality in critically ill patients. There has been considerable progress in understanding the mechanisms that initiate and propagate ALI/ARDS. Although lung protective mechanical ventilation strategy is the only therapy that has been shown to reduce mortality and the development of organ failure in patients with ALI/ARDS, several biologic pathways have been identified and provided an opportunity for therapeutic interventions. The roles of potential pharmacologic and adjunctive therapies were reviewed and at this time there are no treatments available to use today. Clinical studies have demonstrated that prone position in patients with ALI/ARDS results in significant and clinically relevant improvement in oxygenation and ventilation. These changes can persist in patients when they are returned to supine position; and the beneficial response is not limited to patients who are turned early in the course of the disease. The incidence of complications associated with the use of prone ventilation is small. Clinical experience suggests that prone ventilation may protect the lung from the potential detrimental effects of mechanical ventilation and further studies are needed to characterize these findings.