Ventilatory strategies in acute respiratory distress syndrome: impact on mortality and complications

Abstract Acute respiratory distress syndrome (ARDS) is a critical condition characterized by severe hypoxemia and diffuse alveolar damage. Ventilatory strategies play a fundamental role in its management, with protective ventilation with low tidal volume being the current standard to reduce ventilator-induced lung injury. The use of optimal positive end-expiratory pressure (PEEP) and prone positioning have shown benefits in patients with severe hypoxemia, improving oxygenation and reducing mortality. Recently, extracorporeal membrane oxygenation (ECMO) has emerged as an option in refractory cases. However, challenges remain in individualizing therapy and preventing associated complications. This review analyzes current and emerging ventilatory approaches, providing a comprehensive view to optimize the management of ARDS in critically ill patients. Keywords: ARDS, protective ventilation, PEEP, prone ventilation, ECMO.