Management of patients with severe lung injury: first, do no harm.
Severe acute lung injury may result from many infectious and other insults. Although the initial insult may cause overwhelming tissue damage with subsequent gas exchange impairment and risk of death, several strategies of management may also add substantial toxicity. This review focuses on damage incurred by recently identified toxic ventilator settings e.g., high inflation pressures, too low settings of positive end-expiratory pressure, and too high tidal volumes. Liberal fluid management may be another important source of toxicity. The evidence from the literature for survival advantage of lung protective and other strategies is critically reviewed.
van der Werf
T S
TS
Intensive and Respiratory Care Unit, Department of Internal Medicine, Groningen University Hospital, P.O. Box 30.001, 9700 RB Groningen, The Netherlands. t.s.van.der.werf@int.azg.nl
D015199:Extracorporeal Membrane Oxygenation; D005440:Fluid Therapy / Q000009:adverse effects / Q000379:methods; D006801:Humans; D011175:Positive-Pressure Respiration / Q000009:adverse effects / Q000379:methods; D012121:Respiration, Artificial / Q000379:methods; D012128:Respiratory Distress Syndrome / Q000209:etiology / Q000628:therapy*; D012138:Respiratory Therapy / Q000379:methods