title: Novel approaches to minimize ventilator-induced lung injury.
abstract: OBJECTIVE
  To discuss the mechanisms of ventilator-induced lung injury and the pro and cons of the different approaches proposed by literature to minimize its impact in patients with acute respiratory distress syndrome.
  
  
  RESULTS
  Mechanical ventilation is indispensable to manage respiratory failure. The evolution of knowledge of the physiological principles and of the clinical implementation of mechanical ventilation is characterized by the shift of interest from its capability to restore 'normal gas exchange' to its capability of causing further lung damage and multisystem organ failure.
  
  
  CONCLUSIONS
  If one of the essential teachings to young intensivists in the 1980s was to ensure mechanical ventilation restored being able to immediately drain a pneumothorax (barotrauma), nowadays priority we teach to young intensivists is to implement 'protective' ventilation to protect the lungs from the pulmonary and systemic effects of ventilator-induced lung injury (biotrauma). At the same time, priority of clinical research shifted from the search of optimal ventilator settings (best positive end-expiratory pressure) and to the evaluation of 'super-protective' ventilation that integrating partial or total extracorporeal support tries to minimize the use of mechanical ventilation.
authors.affiliation: Dipartimento di Scienze Chirurgiche, Università di Torino and Dipartimento di Anestesiologia e Rianimazione, AOU Città della Salute e della Scienza, Torino, Italy.
authors.forename: Pierpaolo
authors.initials: P
authors.lastname: Terragni
authors.forename: Vito Marco
authors.initials: VM
authors.lastname: Ranieri
authors.forename: Luca
authors.initials: L
authors.lastname: Brazzi
mesh_terms: D015199:Extracorporeal Membrane Oxygenation / Q000295:instrumentation; D006801:Humans; D011175:Positive-Pressure Respiration / Q000009:adverse effects / Q000379:methods*; D012128:Respiratory Distress Syndrome / Q000628:therapy*; D013990:Tidal Volume; D055397:Ventilator-Induced Lung Injury / Q000517:prevention & control*