Ventilator-induced lung injury: The anatomical and physiological framework

Luciano Gattinoni, Alessandro Protti, Pietro Caironi, Eleonora Carlesso

Research output: Contribution to journalArticle

Abstract

Since its introduction into the management of the acute respiratory distress syndrome, mechanical ventilation has been so strongly interwoven with its side effects that it came to be considered as invariably dangerous. Over the decades, attention has shifted from gross barotrauma to volutrauma and, more recently, to atelectrauma and biotrauma. In this article, we describe the anatomical and physiologic framework in which ventilator-induced lung injury may occur. We address the concept of lung stress/strain as applied to the whole lung or specific pulmonary regions. We challenge some common beliefs, such as separately studying the dangerous effects of different tidal volumes (end inspiration) and end-expiratory positive pressures. Based on available data, we suggest that stress at rupture is only rarely reached and that high tidal volume induces ventilator-induced lung injury by augmenting the pressure heterogeneity at the interface between open and constantly closed units. We believe that ventilator-induced lung injury occurs only when a given threshold is exceeded; below this limit, mechanical ventilation is likely to be safe.

Original languageEnglish
JournalCritical Care Medicine
Volume38
Issue number10 SUPPL.
DOIs
Publication statusPublished - Oct 2010

Keywords

  • Acute lung injury
  • Acute respiratory distress syndrome
  • Chest wall elastance
  • Lung elastance
  • Lung mechanics
  • Lung strain
  • Lung stress
  • Lung volumes
  • Transpulmonary pressure
  • Ventilator-induced lung injury

ASJC Scopus subject areas

  • Critical Care and Intensive Care Medicine

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