Daniel Brodie, M.D., and Matthew Bacchetta, M.D. N Engl J Med 2011; 365:1905-1914November 17, 2011
A 41-year-old woman presents with severe community-acquired pneumococcal pneumonia. Chest radiography reveals diffuse bilateral infiltrates, and hypoxemic respiratory failure develops despite appropriate antibiotic therapy.
She is intubated and mechanical ventilation is initiated with a volume- and pressure-limited approach for the acute respiratory distress syndrome (ARDS). Over the ensuing 24 hours, her partial pressure of arterial oxygen (PaO2) decreases to 40 mm Hg, despite ventilatory support with a fraction of inspired oxygen (FIO2) of 1.0 and a positive end-expiratory pressure (PEEP) of 20 cm of water. She is placed in the prone position and a neuromuscular . . .
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