EVALUATION OF THE USE OF MECHANICAL VENTILATION IN ACUTE RESPIRATORY FAILURE

Abstract

Introduction: Acute respiratory failure (ARF) is a highly severe clinical condition and a leading cause of intensive care unit (ICU) admission worldwide. Characterized by the respiratory system's inability to maintain adequate gas exchange, ARF frequently requires mechanical ventilation. Mechanical ventilation (MV) has established itself as an indispensable life-support therapy, aiming to reverse hypoxemia, correct respiratory acidosis, and reduce respiratory muscle workload. However, despite its life-saving role, the use of MV is not without risks, and can induce or aggravate lung injury (ventilator-induced lung injury - VILI), making its correct indication and parameterization a central challenge in intensive care medicine. Objective: The objective of this systematic review was to evaluate and synthesize the comparative scientific evidence on the different mechanical ventilation modalities and strategies in the management of acute respiratory failure in adult patients, focusing on its impact on clinical outcomes such as mortality, ventilation time, and associated complications. Methodology: A systematic literature review was conducted in accordance with the PRISMA guidelines, including articles published in the last ten years. The search was conducted in the PubMed, Scielo, and Web of Science databases, using the descriptors: "mechanical ventilation," "respiratory failure," "intensive care units," "noninvasive ventilation," and "lung injury." The inclusion criteria were: randomized clinical trials comparing different modalities or parameters of MV; studies of adult ICU patients with ARF; and studies reporting relevant clinical outcomes. Studies in pediatric populations, case reports, and literature reviews were excluded. Results: The results demonstrated a growing indication for noninvasive ventilation (NIV) as a first-line approach in specific etiologies of ARF, such as exacerbation of Chronic Obstructive Pulmonary Disease (COPD) and acute cardiogenic pulmonary edema, where its use significantly reduced the rates of orotracheal intubation and complications. For patients requiring invasive mechanical ventilation, especially those with Acute Respiratory Distress Syndrome (ARDS), evidence has solidified the superiority of protective ventilation strategies. The use of low tidal volumes (approximately 6 ml/kg predicted body weight), titrated positive end-expiratory pressure (PEEP), and plateau pressure limitation were consistently associated with reduced mortality. Conclusion: The management of acute respiratory failure with ventilatory support has evolved into a more careful and protective practice. The choice between invasive and non-invasive modalities depended fundamentally on the etiology of ARF and the patient's characteristics. Once invasive ventilation was indicated, the adoption of lung-protective strategies was confirmed as an essential pillar of treatment, representing one of the interventions with the greatest impact on reducing mortality in critically ill patients in recent decades.