From the Research
Ventilation strategies for patients with aspiration pneumonitis should focus on lung-protective ventilation with low tidal volumes of 6-8 mL/kg of predicted body weight and plateau pressures below 30 cmH2O to prevent ventilator-induced lung injury. The most recent and highest quality study to guide ventilation strategies in patients with severe respiratory distress, including those with aspiration pneumonitis, is the ARDSNet trial 1, which demonstrated that ventilation with lower tidal volumes (6 mL/kg of predicted body weight) as compared with traditional tidal volumes (12 mL/kg) resulted in lower mortality and more days without ventilator use.
Key Ventilation Strategies
- Initial settings typically include FiO2 titrated to maintain SpO2 >92%
- PEEP of 5-10 cmH2O adjusted based on oxygenation response
- Respiratory rates of 16-20 breaths per minute
- For severe hypoxemia, higher PEEP levels (10-15 cmH2O) may be necessary
- Prone positioning for 16 hours daily should be considered if PaO2/FiO2 ratio remains <150 despite optimized ventilation
- Permissive hypercapnia (allowing pH >7.25) is acceptable to avoid excessive ventilatory pressures
- Recruitment maneuvers may help open collapsed alveoli, but should be performed cautiously to avoid barotrauma
- Daily sedation interruption and spontaneous breathing trials should be implemented when feasible to assess readiness for extubation These strategies aim to minimize further lung injury while supporting gas exchange during the inflammatory response to aspirated material, which typically causes direct lung injury with surfactant dysfunction, alveolar collapse, and ventilation-perfusion mismatch. While other studies, such as those on extracorporeal carbon dioxide removal 2, preemptive alveolar recruitment strategy 3, lower tidal volume strategy combined with extracorporeal CO2 removal 4, and high positive end-expiratory pressure, low tidal volume ventilatory strategy 5, provide valuable insights into ventilation management, the ARDSNet trial 1 remains the most influential in guiding lung-protective ventilation strategies for patients with aspiration pneumonitis.