Ventilator-associated lung injury.
There is injury caused in numerous animal species when overdistending airway pressure and volume are delivered. The extent of this injury is attenuated by the application of PEEP. Patient case series point to the benefit of LPVS. In randomized controlled trials, the data may appear confusing. However, based on the data from the Amato and colleagues' trial, it seems prudent to employ an LPVS based on the individual patient's lung mechanics. Based on the trials discussed it appears that many have been convinced of the detrimental effects of high peak alveolar pressure. It remains to convince clinicians of the beneficial effects of the use of higher PEEP early in ARDS based on respiratory system mechanics of the individual patient and to use recruitment maneuvers. In conclusion, I concur with Dreyfuss and Saumon and Slutsky and Tremblay that the use of an LPVS may not only attenuate the severity of ARDS by preventing VALI, but may also prevent MODS or attenuate its severity.
Kacmarek
R M
RM
Department of Anaesthesia, Harvard Medical School, Boston, MA, USA.
D000818:Animals; D001469:Barotrauma / Q000503:physiopathology; D016207:Cytokines / Q000502:physiology; D006801:Humans; D055370:Lung Injury; D011175:Positive-Pressure Respiration; D012121:Respiration, Artificial / Q000009:adverse effects*; D014947:Wounds and Injuries / Q000503:physiopathology
D016207:Cytokines