ABSTRACT
Acute lung injury and acute respiratory distress syndrome (ALI/ARDS)
are life-threatening disorders associated with severe impairments of respiratory gas exchange. Without mechanical ventilation (MV), many
patients with ALI/ARDS would die from hypoxemic and hypercarbic
respiratory failure. MV allows time for treatment of the underlying condi-
tions that cause ALI/ARDS, such as pneumonia and sepsis, and for natural
healing processes. However, MV can also cause ALI [ventilator-induced
lung injury (VILI)], which may delay or prevent recovery. Modifications
of traditional MV techniques can reduce VILI and improve the likelihood
of recovery. These modifications include the use of relatively small tidal volumes with low inspiratory pressures (volume-and-pressure limitation)
and relatively high levels of positive end-expiratory pressure (higher
PEEP). In this chapter, we review the traditional approach to MV, the
experimental data that motivated investigators to study lung-protective
modifications of the traditional approach, and the results of clinical studies
that compare different MV approaches.
