Spontaneous breathing during mechanical ventilation in acute respiratory distress syndrome patients

Mechanical ventilation is the most important support for acute respiratory distress syndrome (ARDS) patients.Spontaneous breathing (SB) can promote pulmonary revascularization, improve ventilation/blood flow ratio, improve pulmonary blood perfusion distribution, improve gas exchange, prevent ventilator-related diaphragmatic injury, improve systemic hemodynamics and organ perfusion, reduce lung injury and inflammatory responses, and shorten mechanical ventilation time and ICU hospitalization time.However, strong SB can lead to excessive tidal volume and inestimable transpulmonary pressure (PL), increasing the risk of lung injury and thus mortality.Lacking of effective respiratory mechanics monitoring remains questions for pediatric patients.When conducting mechanical ventilation on ARDS patients, whether to retain spontaneous respiration rely on the severity of the disease.In general, SB tends to be retained in mild to moderate ARDS patients.Respiratory mechanics monitoring in children including tidal volume (Vt), platform pressure (Pplat), PL, and esophageal pressure (Pes) help to manage the spontaneous breathing during mechanical ventilation in order to reduce the risk of lung injury. Key words: Acute respiratory distress syndrome; Mechanical ventilation; Spontaneous breathing; Lung injury; Children