chapter  8
18 Pages

Cellular and Molecular Basis for Ventilator-Induced Lung Injury

Evidence has accumulated over the past decade that although mechanical

ventilation has helped many patients with respiratory failure, it can also cause damage to the lungs, particularly during the course of the acute

respiratory distress syndrome (ARDS). The mortality rate of patients with

this syndrome remains high, generally exceeding 30% to 40%. A recent study by the ARDS Network (1) has demonstrated that patients subjected

to low tidal volume ventilation associated with positive end expiratory pres-

sure (PEEP) had a significantly lower mortality than patients receiving

higher tidal volumes. This indicated that the ventilatory strategy signifi-

cantly influenced mortality. In addition to direct lung injury and air leaks (2), mechanical ventilation is responsible for worsening acute lung injury

by triggering lung and systemic inflammation (3-6). This process is now

widely known as ventilator-induced lung injury (VILI) (4,7,8).