Robert A. Lachmann, MSc, Jack J. Haitsma, MD, and Burkhard Lachmann, MD, PhD. Department of Anaesthesiology, Erasmus Medical Centre Rotterdam, The Netherlands.

Professor Lachmann has obtained the reputation as the open lung man. He has worked for many years with respiratory problems and developed the technique for reducing atelectasis in patients on ventilator. During the international joint meeting with the Czech Society of Anaesthesiology and the CENSA Oct 2002, he gave an inspired lecture on the status for ventilation during ARDS.

Introduction

ARDS was mentioned in an historic article by David Ashbaugh and colleagues in 1967. They described 12 patients with severe dyspnoea, tachypnoea, cyanosis, loss of lung compliance and diffuse alveolar infiltration seen on the chest X-ray [1]. They observed and reported several clinical and pathological similarities with neonates with respiratory distress syndrome, notably surfactant dysfunction [1].

What did we learn from the last ten years of mechanical ventilation?

In 1990 Hickling and colleagues demonstrated that mechanical ventilation could influence mortality in ARDS patients [3]. Lowering tidal volume (TV) in a retrospective study of 50 ARDS patients decreased mortality [3]. The outcome of this study sparked renewed interest in lowering TV in ARDS patients.

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