Reduced tidal volumes and lung protective ventilatory strategies: where do we go from here?
Three major determinants of lung injury associated with mechanical ventilation have been clearly identified: high pressure/high volume, the shear forces caused by intratidal collapse and decollapse leading to barotrauma/volotrauma/biotrauma. The lung protective strategy aims to reduce the impact of all three determinants. A groundbreaking study showed that reduced tidal volume is less dangerous than high tidal volume, but the researchers did not apply "full" lung protective strategy and did not take into account the shear forces. "Full" protective lung strategy was tested in only one study and in a limited number of patients. Several physiologic studies strongly suggest the advantages of the lung protective strategy.
Istituto di Anestesia e Rianimazione, Universita' degli Studi di Milano, Ospedale Policlinico-IRCCS, Milano, Italy. gattinon@polic.cilea.it
Luciano
L
Gattinoni
Davide
D
Chiumello
Riccarda
R
Russo
D001469:Barotrauma / Q000209:etiology / Q000517:prevention & control*; D006801:Humans; D055370:Lung Injury; D011175:Positive-Pressure Respiration / Q000009:adverse effects / Q000379:methods*; D012123:Pulmonary Ventilation / Q000502:physiology; D012128:Respiratory Distress Syndrome / Q000209:etiology / Q000517:prevention & control / Q000628:therapy; D013990:Tidal Volume / Q000502:physiology*