ABSTRACT
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.
