Nichtinvasives beatmungsregime und liberales volumenmanagement bei schwerem ards mit septischer genese - Eine kasuistik

Early stages of ARDS are characterized by pulmonary edema caused by a inflammatory mediated leakage of the capillary-alveolar membranes. Therefore restrictive fluid management is commonly recommended. The main reason for ARDS, however, is sepsis. In sepsis, fluid restriction may be harmful because this can attenuate cardiac output while hyperdynamic circulation is needed to maintain aerobic metabolism of the non-pulmonary organs. So if ARDS is caused by sepsis we face a therapeutic dilemma, on the one hand, to reduce circulatory fluid to improve ventilation and, on the other hand to raise circulatory fluid to optimize hemodynamics. Another important treatment approach of ARDS is early mechanical ventilation with intubation. Mechanical ventilation however can induce further progression of lung injury. Besides using low-volume pressure-limited ventilation with permissive hypercapnia, non-invasive ventilation has recently been proposed as an efficient alternative to conventional mechanical ventilation in the treatment of ARDS. We present a case report of ARDS caused by urosepsis in a young patient. The positive course with fast recovery is associated, in our opinion, to the causal relationship of a non-invasive ventilation regiment and liberal fluid management.