Respiratory Physiology as a Basis for the Management of Acute Lung Injury
Despite significant improvement in management and outcome, the mortality rate of the acute respiratory distress syndrome (ARDS) remains very high, ranging from 35 to 65% . Mechanical ventilation is a mainstay of therapy and is used to maintain adequate systemic oxygenation and to rest the respiratory muscles . However, over the last two decades, research in a number of species has shown that mechanical ventilation itself can produce acute lung injury (ALI) that is functionally and histologically indistinguishable from ARDS . The postulated mechanisms responsible for ventilator-induced lung injury (VILI) relate to the mechanical stress placed on the pulmonary and non-pulmonary structures by mechanical ventilation . If these animal studies can be directly extrapolated to humans they suggest that mechanical ventilation may be a very important determinant of the high mortality in ARDS.
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