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Ventilator-induced lung injury

J‐D. Ricard, D. Dreyfuss, G. Saumon
European Respiratory Journal 2003 22: 2s-9s; DOI: 10.1183/09031936.03.00420103
J‐D. Ricard
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D. Dreyfuss
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G. Saumon
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Abstract

During mechanical ventilation, high end-inspiratory lung volume (whether it be because of large tidal volume (VT) and/or high levels of positive end-expiratory pressure) results in a permeability type pulmonary oedema, called ventilator-induced lung injury (VILI). Previous injury sensitises lung to mechanical ventilation.

This experimental concept has recently received a resounding clinical illustration after a 22% reduction of mortality was observed in acute respiratory distress syndrome patients whose VT had been reduced. In addition, it has been suggested that repetitive opening and closing of distal units at low lung volume could induce lung injury but this notion has been challenged both conceptually and clinically after the negative results of the Acute Respiratory Distress Syndrome clinical Network Assessment of Low tidal Volume and Elevated end-expiratory volume to Obviate Lung Injury (ARDSNet ALVEOLI) study.

Experimentally and clinically, involvement of inflammatory cytokines in VILI has not been unequivocally demonstrated. Cellular response to mechanical stretch has been increasingly investigated, both on the epithelial and the endothelial side. Lipid membrane trafficking has been thought to be a means by which cells respond to stress failure.

Alterations in the respiratory system pressure/volume curve during ventilator-induced lung injury that include decrease in compliance and position of the upper inflection point are due to distal obstruction of airways that reduce aerated lung volume. Information from this curve could help avoid potentially harmful excessive tidal volumereduction.

  • acute respiratory distress syndrome
  • cytokines
  • inflammation
  • mechanical ventilation
  • ventilator-induced lung injury
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Ventilator-induced lung injury
J‐D. Ricard, D. Dreyfuss, G. Saumon
European Respiratory Journal Aug 2003, 22 (42 suppl) 2s-9s; DOI: 10.1183/09031936.03.00420103

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Ventilator-induced lung injury
J‐D. Ricard, D. Dreyfuss, G. Saumon
European Respiratory Journal Aug 2003, 22 (42 suppl) 2s-9s; DOI: 10.1183/09031936.03.00420103
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  • Article
    • Abstract
    • Evidence for ventilator-induced lung injury
    • Roles of tidal volume, positive end-expiratory pressure, and overall lung distention
    • Possible mechanisms of ventilator-induced lung injury
    • New insights in ventilator-induced lung injury: cellular response to mechanical strain
    • Strategies to reduce ventilator-induced lung injury: use of the pressure/volume curve
    • Conclusion and clinical applications
    • References
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