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.
KeywordsTidal Volume Acute Lung Injury Acute Respiratory Distress Syndrome Respir Crit Ventilatory Strategy
Unable to display preview. Download preview PDF.
- 8.National Institute of Health (1999) ARDS clinical network. Available at htpp:/hedwig.mgh. harvard.edu./ardsnet/nih.html. Posted March 15, 1999Google Scholar
- 9.Hudson L (1999) Progress in understanding ventilator induced lung injury JAMA 282: 77–78Google Scholar
- 12.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: 730–736Google Scholar
- 13.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: 710–720PubMedCrossRefGoogle Scholar
- 18.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)Google Scholar
- 22.Brochard L (1998) Respiratory pressure-volume curves. In: Tobin MJ (ed) Principle and practice of intensive care monitoring. McGraw-Hill, New York, pp 597–616Google Scholar