Abstract
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% [1]. Mechanical ventilation is a mainstay of therapy and is used to maintain adequate systemic oxygenation and to rest the respiratory muscles [2]. 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 [3]. 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 [3]. 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.
This is a preview of subscription content, log in via an institution to check access.
Access this chapter
Tax calculation will be finalised at checkout
Purchases are for personal use only
Preview
Unable to display preview. Download preview PDF.
References
Milberg JA, Davis DR, Steinberg KP, Hudson LD (1995) Improved survival of patients with acute respiratory distress syndrome (ARDS): 1983–1993. JAMA 273: 306–309
Tobin MJ (1994) Mechanical ventilation. N Engl J Med 330: 1056–1061
Slutsky AS, Tremblay LN (1998) Multiple system organ failure: Is mechanical ventilation a contributing factor? Am J Respir Crit Care Med 157: 1721–1725
Stewart TE, Meade MO, Cook DJ, et al (1998) Evaluation of a ventilation strategy to prevent barotrauma in patients at high risk for acute respiratory distress syndrome. N Engl J Med 338: 355–361
Brochard L, Roudot-Thoraval F, Roupie E, et al (1998) Tidal volume reduction for prevention of ventilator-induced lung injury in the acute respiratory distress syndrome. Am J Respir Crit Care Med. 158: 1831–1838
Amato MBP, Barbas CSV, Medeiros DM, et al (1998) Effect of a protective-ventilation strategy on mortality in the acute respiratory distress syndrome. N Engl J Med 338: 347–354
Ranieri VM, Suter PM, Tortorella C, et al (1999) Effect of mechanical ventilation on inflammatory mediators in patients with acute respiratory distress syndrome: a randomized controlled trial. JAMA 282: 54–61
National Institute of Health (1999) ARDS clinical network. Available at htpp:/hedwig.mgh. harvard.edu./ardsnet/nih.html. Posted March 15, 1999
Hudson L (1999) Progress in understanding ventilator induced lung injury JAMA 282: 77–78
Gattinoni L, Pesenti A, Bombino M, et al (1988) Relationship between lung computed torno-graphic density gas-exchange and PEEP in acute respiratory failure. Anesthesiology 69: 824–832
Mead J, Takishima T, Leith D (1970) Stress distribution in lungs: a model of pulmonary elasticity. J Appl Physiol 28: 596–608
Gattinoni L, Pesenti A, Avalli L, Rossi F, Bombino M (1987) Pressure-volume curve of total respiratory system in acute respiratory failure. Computed tomographic scan study. Am Rev Respir Dis 136: 730–736
Ranieri VM, Mascia L, Fiore T, Bruno F, Brienza A, Giuliani R (1995) Cardiorespiratory effects of positive end-expiratory pressure during progressive tidal volume reduction (permissive hypercapnia) in patients with acute respiratory distress syndrome. Anesthesiology 83: 710–720
Muscedere JG, Mullen JB, Gan K, Slutsky AS (1994) Tidal ventilation at low airway pressures can augment lung injury. Am J Respir Crit Care Med 149: 1327–1334
Rouby JJ, Lherme T, de Lassale EM, et al (1993) Histologic aspects of pulmonary barotrauma in critically ill patients with acute respiratory failure. Intensive Care Med 19: 383–389
Ito Y, Veldhuizen RAW, Yao L, et al (1997) Ventilation strategies affect surfactant aggregate conversion in acute lung injury. Am J Respir Crit Care Med 155: 493–499
Tremblay L, Valenza F, Ribeiro SP, Li J, Slutsky AS (1997) Injurious ventilatory strategies increase cytokines and c-fos m-RNA expression in an isolated rat lung model. J Clin Invest 99: 944–952
Ranieri VM, Puntillo F, Grasso S, et al (1998) Limitation of mechanical lung stress decreases BAL cytokines in patients with ARDS. Intensive Care Med 24: S130 (Abst)
von Bethmann AN, Brasch F, Nusing R, et al (1998) Hyperventilation induces release of cytokines from perfused mouse lung. Am J Respir Crit Care Med 157: 263–272
Chiumello D, Pristine G, Baba A, Slutsky AS (1999) Mechanical ventilation affects local and systemic cytokines in an animal model of ARDS. Am J Respir Crit Care Med 160: 109–115
Wang N, Butler JP, Ingber DE (1993) Mechanotransduction across the cell surface and through the cytoskeleton. Science 260: 1124–1127
Brochard L (1998) Respiratory pressure-volume curves. In: Tobin MJ (ed) Principle and practice of intensive care monitoring. McGraw-Hill, New York, pp 597–616
Slutsky AS (1993) Mechanical ventilation. American College of Chest Physicians’ Consensus Conference. Chest 104: 1833–1859
Albert RK (1985) Least PEEP: primum non nocere. Chest 87: 2–4
Muscedere JG, Mullen JB, Gan K, Slutsky AS (1994) Tidal ventilation at low airway pressures can augment lung injury. Am J Respir Crit Care Med 149: 1327–1334
Tremblay L, Valenza F, Ribeiro SP, Li J, Slutsky AS (1997) Injurious ventilatory strategies increase cytokines and c-fos m-RNA expression in an isolated rat lung model. J Clin Invest 99: 944–952
Hickling KG (1998) The pressure-volume curve is greatly modified by recruitment: A mathematical model of ARDS lungs. Am J Respir Crit Care Med 158: 194–202
Pelosi P, Cereda P, Foti G, et al (1995) Alterations of lung and chest wall mechanics in patients with acute lung injury: effects of positive end-expiratory pressure. Am J Respir Crit Care Med 152: 531–537
Mergoni M, Martelli A, Volpi A, et al (1997) Impact of positive end-expiratory pressure on chest wall and lung pressure-volume curve in acute respiratory failure. Am J Respir Crit Care Med 156: 846–854
Ranieri VM, Brienza N, Santostasi S, et al (1997) Impairment of lung and chestwall mechanics in patients with acute respiratory distress syndrome: role of abdominal distension. Am J Respir Crit Care Med 156: 1082–1091
Gattinoni L, Pelosi P, Suter PM, Pedoto A, Vercesi P, Lissoni A (1998) Acute respiratory distress syndrome caused by pulmonary and extrapulmonary disease. Different syndromes? Am J Respir Crit Care Med 158: 3–11
Ranieri VM, Slutsky AS (1999) Respiratory physiology and acute lung injury: the miracle of Lazarus. Intensive Care Med 25: 1040–1043
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 2000 Springer-Verlag Berlin Heidelberg
About this paper
Cite this paper
Grasso, S., Giunta, F., Ranieri, V.M. (2000). Respiratory Physiology as a Basis for the Management of Acute Lung Injury. In: Vincent, JL. (eds) Yearbook of Intensive Care and Emergency Medicine 2000. Yearbook of Intensive Care and Emergency Medicine, vol 2000. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-662-13455-9_25
Download citation
DOI: https://doi.org/10.1007/978-3-662-13455-9_25
Publisher Name: Springer, Berlin, Heidelberg
Print ISBN: 978-3-540-66830-5
Online ISBN: 978-3-662-13455-9
eBook Packages: Springer Book Archive