open access

Vol 45, No 3 (2013 Jul-Sep)
Review articles
Submitted: 2013-09-25
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Ventilator-associated lung injury

Katarzyna Kuchnicka, Dariusz Maciejewski
DOI: 10.5603/AIT.2013.0034
·
Anaesthesiol Intensive Ther 2013;45(3):164-170.

open access

Vol 45, No 3 (2013 Jul-Sep)
Review articles
Submitted: 2013-09-25

Abstract

Mechanical ventilation of disease-affected lungs, as well as being an inadequate mode of ventilation for initially healthy lungs, can cause significant changes in their structure and function. In order to differentiate these processes, two terms are used: ventilator-associated lung injury (VALI) and ventilator-induced lung injury (VILI). In both cases, lung injury primarily results from differences in transpulmonary pressure — a consequence of an imbalance between lung stress and strain. This paper focuses on changes in lung structure and function due to this imbalance. Moreover, in this context, barotrauma, volutrauma and atelectrauma are interpreted, and the importance of signal transduction as a process inducing local and systemic inflammatory responses (biotrauma), is determined. None of the assessed methods of reducing VALI and VILI has been found to be entirely satisfactory, yet studies evaluating oscillatory ventilation, liquid ventilation, early ECMO, super-protective ventilation or noisy ventilation and administration of certain drugs are under way. Low tidal volume ventilation and adequately adjusted PEEP appear to be the best preventive measures of mechanical ventilation in any setting, including the operating theatre. Furthermore, this paper highlights the advances in VILI/VALI prevention resulting from better understanding of pathophysiological phenomena.

Abstract

Mechanical ventilation of disease-affected lungs, as well as being an inadequate mode of ventilation for initially healthy lungs, can cause significant changes in their structure and function. In order to differentiate these processes, two terms are used: ventilator-associated lung injury (VALI) and ventilator-induced lung injury (VILI). In both cases, lung injury primarily results from differences in transpulmonary pressure — a consequence of an imbalance between lung stress and strain. This paper focuses on changes in lung structure and function due to this imbalance. Moreover, in this context, barotrauma, volutrauma and atelectrauma are interpreted, and the importance of signal transduction as a process inducing local and systemic inflammatory responses (biotrauma), is determined. None of the assessed methods of reducing VALI and VILI has been found to be entirely satisfactory, yet studies evaluating oscillatory ventilation, liquid ventilation, early ECMO, super-protective ventilation or noisy ventilation and administration of certain drugs are under way. Low tidal volume ventilation and adequately adjusted PEEP appear to be the best preventive measures of mechanical ventilation in any setting, including the operating theatre. Furthermore, this paper highlights the advances in VILI/VALI prevention resulting from better understanding of pathophysiological phenomena.

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Keywords

mechanical ventilation, ventilator-associated lung injury; mechanical ventilation, lung protective ventilation

About this article
Title

Ventilator-associated lung injury

Journal

Anaesthesiology Intensive Therapy

Issue

Vol 45, No 3 (2013 Jul-Sep)

Pages

164-170

DOI

10.5603/AIT.2013.0034

Bibliographic record

Anaesthesiol Intensive Ther 2013;45(3):164-170.

Keywords

mechanical ventilation
ventilator-associated lung injury
mechanical ventilation
lung protective ventilation

Authors

Katarzyna Kuchnicka
Dariusz Maciejewski

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