Document Detail

Protective ventilation of patients with acute respiratory distress syndrome.
MedLine Citation:
PMID:  14722180     Owner:  NLM     Status:  MEDLINE    
The majority of patients with acute respiratory distress syndrome (ARDS) require mechanical ventilation. This support provides time for the lungs to heal, but the adverse effects of mechanical ventilation significantly influence patient outcome. Traditionally, these were ascribed to mechanical effects, such as haemodynamic compromise from decreased venous return or gross air leaks induced by large transpulmonary pressures. More recently, however, the ARDS Network study has established the clinical importance of lowering the tidal volume to limit overdistension of the lung when ventilating patients with ARDS. This study suggests that ventilator-associated lung injury (VALI) caused by overdistension of the lung contributes to the mortality of patients with ARDS. Moreover, the results from clinical and basic research have revealed more subtle types of VALI, including upregulation of the inflammatory response in the injured and overdistended lung. This not only damages the lung, but the overflow of inflammatory mediators into the systemic circulation may explain why most patients who die with ARDS succumb to multi-organ failure rather than respiratory failure. The results of these studies, the present understanding of the pathophysiology of VALI, and protective ventilatory strategies are reviewed.
E D Moloney; M J D Griffiths
Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't; Review    
Journal Detail:
Title:  British journal of anaesthesia     Volume:  92     ISSN:  0007-0912     ISO Abbreviation:  Br J Anaesth     Publication Date:  2004 Feb 
Date Detail:
Created Date:  2004-01-14     Completed Date:  2004-02-24     Revised Date:  2008-11-21    
Medline Journal Info:
Nlm Unique ID:  0372541     Medline TA:  Br J Anaesth     Country:  England    
Other Details:
Languages:  eng     Pagination:  261-70     Citation Subset:  IM    
Imperial College School of Medicine at the National Heart and Lung Institute, Royal Brompton Hospital, London, UK.
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MeSH Terms
Barotrauma / etiology
Lung Injury
Respiration, Artificial / adverse effects,  methods*
Respiratory Distress Syndrome, Adult / physiopathology,  therapy*
Comment In:
Br J Anaesth. 2004 Jun;92(6):906; author reply 906-7   [PMID:  15145838 ]
Br J Anaesth. 2004 Jul;93(1):153; author reply 153   [PMID:  15192007 ]

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