Ventilator - Induced Lung Injury

By Neil R. MacIntyre, MD, FCCP

Conclusions

There are strong animal and human data suggesting that distending lung regions beyond the normal maximal transalveolar pressure of 30 to 35 cm H₂O produces both a direct lung injury (VILI) as well as a release of inflammatory mediators into the circulation (biotrauma). Animal data also suggest that additional injury results from inadequate alveolar recruitment. Ventilator management strategies aimed at limiting maximal distention (and optimizing recruitment) are called lung-protective strategies. Because minute ventilation may be compromised by these strategies, gas exchange may suffer in a tradeoff for this protection. Recent clinical trial results showing mortality benefits to lung protection, however, provide strong evidence that this tradeoff is worth it. Although there are novel ventilatory strategies and pharmacologic agents that may be used to reduce or eliminate VILI, the reduction of the need for invasive PPV (eg, by the use of mask ventilation), the incorporation of lung-protective strategies during respiratory failure requiring PPV, and the prompt recognition of ventilator withdrawal potential (eg, weaning protocols) are probably the best current strategies for reducing or preventing VILI.

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