RT Book, Section
A1 Dreyfuss, Didier
A1 Prost, Nicolas de
A1 Ricard, Jean-Damien
A1 Saumon, Georges
A2 Tobin, Martin J.
SR Print(0)
ID 57074964
T1 Chapter 42. Ventilator-Induced Lung Injury
T2 Principles and Practice of Mechanical Ventilation, 3e
YR 2013
FD 2013
PB The McGraw-Hill Companies
PP New York, NY
SN 978-0-07-173626-8
LK accessanesthesiology.mhmedical.com/content.aspx?aid=57074964
RD 2024/04/23
AB The  deleterious  effects  of  mechanical  ventilation  on  the  lungs  have  long  been  referred  to  as  barotrauma.  For  many  years,  clinicians  defined  barotrauma  as  the  occurrence  of  air  leaks  resulting  in  the  accumulation  of  extraalveolar  air  responsible  for  a  number  of  manifestations,  of  which  the  most  threatening  is  tension  pneumothorax.  In  addition  to  these  “macroscopic”  events  whose  adverse  consequences  are  usually  immediately  obvious,  mechanical  ventilation  may  produce  more  subtle  physiologic  and  morphologic  alterations,  especially  when  it  results  in  high  airway  pressures.  Our  knowledge  of  such  alterations  has  stemmed  mainly  from  experimental  studies  and  has  expanded  considerably  over  recent  years.  Indeed,  alterations  in  alveolar–capillary  barrier  integrity  and  release  of  both  inflammatory  and  antiinflammatory  mediators  have  been  reported  in  animals  ventilated  with  modalities  resulting  in  high  lung  stretching.  Tissue  damage  also  may  occur  during  mechanical  ventilation  when  distal  airways  close  and  open  repeatedly  because  of  the  movement  of  foam  in  the  airway  lumen  or  rupture  of  liquid  menisci.  The  clinical  relevance  of  these  experimental  findings  received  resounding  confirmation  with  the  results  of  the  ARDS  Network  study,  which  showed  a  22%  reduction  in  mortality  in  patients  with  the  acute  respiratory  distress  syndrome  through  a  simple  reduction  in  tidal  volume.1