The "best" tidal volume for managing acute lung injury/acute respiratory distress syndrome.
An inappropriate tidal volume setting can overstretch and injure the lung. Maximal stretch, tidal stretch, frequency of stretch, and rate of stretch are all implicated in such injury. Moreover, the stretch injury produces systemic injury by liberating cytokines and translocating bacteria in the lung. Clinical trials have shown that limiting maximal and tidal stretch improves outcomes, even if gas exchange is partially compromised. Current strategies should focus on limiting tidal and maximal stretch as much as possible.
MacIntyre
Neil R
NR
Department of Pulmonary and Critical Care, Duke University Medical Center, Box 3911, Erwin Road, Durham, NC 27710, USA. macin001@mc.duke.edu
D000818:Animals; D006801:Humans; D011175:Positive-Pressure Respiration / Q000009:adverse effects / Q000379:methods*; D011659:Pulmonary Gas Exchange / Q000502:physiology; D016032:Randomized Controlled Trials as Topic; D012128:Respiratory Distress Syndrome / Q000209:etiology / Q000517:prevention & control* / Q000628:therapy*; D013990:Tidal Volume