[Experimental changes in the alveolo-capillary barrier induced by artificial ventilation].
Mechanical ventilation can have deleterious effects on the lungs. Extra-alveolar escape of air, such as pneumothorax or subcutaneous emphysema, are complications which have long been known. New experimental studies have clearly shown that mechanical ventilation can also result in pathologic changes to the air/blood barrier. Mechanical ventilation with high end-inspiratory pressure and high volume causes lung edema in whose origin abnormal permeability of the alveolo-capillary barrier plays a major role. The abnormalities are in fact the result of pulmonary distention and not of elevated air pressure; this justifies the term "volume traumatism". The presence of a previous acute pulmonary injury considerably increases the deleterious effects of mechanical ventilation on the lungs. Although the clinical implications of these experimental studies are difficult to assess, they have nevertheless resulted in major changes in ventilation strategy for acute lung diseases such as the acute respiratory distress syndrome of the adult.
Dreyfuss
D
D
Service de réanimation médicale, Hôpital Louis Mourier, Colombes.
Saumon
G
G
D000328:Adult; D015824:Blood-Air Barrier / Q000502:physiology*; D002199:Capillary Permeability / Q000502:physiology; D006801:Humans; D008176:Lung Volume Measurements; D011654:Pulmonary Edema / Q000503:physiopathology*; D012121:Respiration, Artificial; D012128:Respiratory Distress Syndrome / Q000503:physiopathology*; D012307:Risk Factors