Recently, advances have been made in the treatment of respiratory failure. One major advance is the use of oxygen as a drug with dose-related efficacy and toxicity. The other major advance is the augmentation of oxygen delivery to the tissue by methods other than increasing the oxygen dose. These new methods include mechanical ventilation and positive end-expiratory pressure (PEEP).
In 1967, Ashbaugh et al first described acute respiratory failure after civilian trauma. They coined the term "adult respiratory distress syndrome" (ARDS) and were the first to recommend PEEP as a treatment modality.1 Acute lung injury resulting in ARDS can result from multiple causes including sepsis, diffuse aspiration pneumonia, shock, pancreatitis, fat embolism, and viral pneumonia.
The ARDS develops in approximately 150,000 patients annually.2 The majority are young and previously had been healthy. Mortality may be greater than 75% in patients requiring an inspired oxygen concentration (F1O