chapter  10
18 Pages

Systemic Effects of Mechanical Ventilation

WithYumiko Imai, Arthur S. Slutsky

The acute respiratory distress syndrome (ARDS), the most severe form of

acute lung injury (ALI), is a devastating clinical syndrome affecting approximately 1,000,000 people worldwide per year. Despite recent advances, the

mortality rate is at least 30% (1). Predisposing factors for ARDS are diverse (2,3) and include sepsis, pneumonia, aspiration, trauma, and severe acute

respiratory syndrome. No drug has been proven to improve the clinical

outcome of ARDS, and therapy is largely supportive with mechanical venti-

lation (MV). However, MV can cause and/or worsen preexisting lung injury,

the so-called ventilator-induced lung injury (VILI). Although the most

obvious clinical and laboratory abnormalities of ARDS are related to the lung, death is usually due to the dysfunction of other organs, termed ‘‘multi-

ple organ dysfunction syndrome’’ (MODS) (1). One hypothesis that has

recently been advanced to explain this observation is that MV per se may

not only be responsible for worsening of the preexisting lung injury but also,

by a number of mechanisms including the development of systemic inflam-

matory response, contribute to the development of MODS (Fig. 1) (4).