Abstract
Ventilation-induced lung injury results from mechanical stress and strain that occur during tidal ventilation in the susceptible lung. Classical descriptions of ventilation-induced lung injury have focused on harm from positive pressure ventilation. However, injurious forces also can be generated by patient effort and patient–ventilator interactions. While the role of global mechanics has long been recognized, regional mechanical heterogeneity within the lungs also appears to be an important factor propagating clinically significant lung injury. The resulting clinical phenotype includes worsening lung injury and a systemic inflammatory response that drives extrapulmonary organ failures. Bedside recognition of ventilation-induced lung injury requires a high degree of clinical acuity given its indistinct presentation and lack of definitive diagnostics. Yet the clinical importance of ventilation-induced lung injury is clear. Preventing such biophysical injury remains the most effective management strategy to decrease morbidity and mortality in patients with acute respiratory distress syndrome and likely benefits others at risk.
Highlights
Acute respiratory failure often requires mechanical ventilation as a potentially life-saving intervention
Lower tidal volumes are used increasingly in patients without ARDS5, and clinical data suggest benefit in patients at risk of ventilation-induced lung injury (VILI) regardless of whether all criteria for acute respiratory distress syndrome (ARDS) are met[6,7,8]
A larger multicenter trial comparing esophageal pressure-guided positive end-expiratory pressure (PEEP) to empiric high PEEP found no significant difference in mortality[37]
Summary
F1000 Faculty Reviews are written by members of the prestigious F1000 Faculty. They are commissioned and are peer reviewed before publication to ensure that the final, published version is comprehensive and accessible. The reviewers who approved the final version are listed with their names and affiliations. Keywords ventilator-induced lung injury, acute respiratory distress syndrome, acute lung injury, respiratory mechanics, mechanical ventilation. Any comments on the article can be found at the end of the article
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