chapter  5
22 Pages

Hemodynamic Interactions During Ventilator-Induced Lung Injury

WithJohn J. Marini, Leopoldo Ferrer

Numerous experimental studies demonstrate the potential for adverse pat-

terns of mechanical ventilation to initiate acute lung injury (ALI), which is characterized by proteinaceous edema, inflammation, and hemorrhage. The

great majority of these investigations into ventilator-induced lung injury

(VILI) have focused on the characteristics of the individual tidal cycle-tidal

volume, inspiratory flow rate, and end-expiratory airway pressure (PEEP).

In the largest and, perhaps, the most widely cited clinical trial of ventilator

strategy in ALI yet undertaken, smaller tidal volumes were associated with

a reduced mortality (1). This result was attributed to the generally lower

peak alveolar pressures and reduced mechanical stresses associated with smaller tidal volumes.