Hitting new barriers in ventilator-induced lung injury

Excerpt

In 2000 the hallmark study by the Acute Respiratory Distress Syndrome (ARDS) Network highlighted the risks immanent to mechanical ventilation with high tidal volumes [1]. Compared to ventilation with low tidal volumes of 6 ml/kg body weight, ventilation with tidal volumes of 12 ml/kg body weight increased mortality and prolonged ventilator use in patients with ARDS or acute lung injury [1]. It had already been recognized for years that ventilation with excessive tidal volumes may cause ultrastructural changes and stress failure of both the epithelial and endothelial barrier. This phenomenon was originally referred to as barotrauma and later, when increased tidal volume rather than peak inspiratory pressure was identified as primary trigger, as volutrauma [2]. More recently it became evident that ventilation strategies below the baro-/volutrauma safety margin may cause lung injury by activation of cellular responses at the alveolocapillary barrier. …