Ventilator-Induced Lung Injury.
- Author:
Je Hyeong KIM
1
Author Information
1. Division of Pulmonary, Sleep and Critical Care Medicine, Department of Internal Medicine, Korea University Ansan Hospital, Ansan, Korea. chepraxis@korea.ac.kr
- Publication Type:Review
- Keywords:
Acute respiratory distress syndrome;
Mechanical ventilation;
Ventilator-induced lung injury
- MeSH:
Cause of Death;
Extracorporeal Membrane Oxygenation;
Humans;
Lung;
Multiple Organ Failure;
Population Characteristics;
Positive-Pressure Respiration;
Prone Position;
Respiration, Artificial;
Respiratory Distress Syndrome, Adult;
Tidal Volume;
Ventilation;
Ventilator-Induced Lung Injury*
- From:Korean Journal of Medicine
2014;86(5):529-536
- CountryRepublic of Korea
- Language:Korean
-
Abstract:
Ventilator-induced lung injury (VILI) is the additional inflammatory damage caused by mechanical ventilation, especially in acute respiratory distress syndrome (ARDS). VILI can induce a systematic inflammatory response, resulting in multiple organ dysfunction syndrome, which is the major cause of death in ARDS patients. The two main mechanisms of VILI are physical stretch injury caused by a high tidal volume and shearing force caused by the reopening and collapse of alveoli in atelectatic lung. Protective ventilation strategies to prevent VILI include low tidal volume ventilation, high positive end-expiratory pressure, prone position ventilation, the alveolar recruitment maneuver, and extracorporeal membrane oxygenation. The clinical support is strongest for low tidal volume ventilation, which should be used in all cases of ARDS. However, its effectiveness might be limited because of the severe spatial heterogeneity of the lung involvement, which cannot completely prevent regional alveolar distension. Although there is insufficient clinical evidence supporting the other strategies, and they are controversial, various strategies other than low tidal volume ventilation should be considered in selected clinical conditions in which they might be effective.
