Respiratory system compliance reflects contributions of both the (ΔV/ΔP transpulmonary), or chest wall compliance (ΔV/ΔP pleural). Respiratory system compliance (ΔV/ΔP airway), lung compliance Injurious inflammatory response to mechanical lung injury.Ĭhange in volume for a given change in pressure. forceful inspiratory effort).Īdditional lung and extra-pulmonary organ injury caused by pro. May occurĮven at lower airway pressure if pleural pressure is extremely Lung injury caused by high transpulmonary pressure. Lung injury caused by high shear forces from cyclic opening andĬollapse of atelectatic but recruitable lung units.Ĭonceptual model for the reduced volume of non-atelectaticĪerated lung available for tidal insufflation and gas exchange in 4 Recent recognition that heterogeneous regional mechanics, stress frequency, and pulmonary capillary stress failure may also contribute to VILI has inspired a renewed line of investigation toward personalizing lung-protective ventilation. 3Ĭlassically, four mechanisms of VILI have been described: barotrauma, volutrauma, atelectrauma, and biotrauma ( Table 1). 1 Over 250 years later, ventilator-induced lung injury (VILI) was proven definitively to contribute to mortality in patients with acute respiratory distress syndrome (ARDS). 1, 2 John Fothergill postulated mouth-to-mouth resuscitation may be preferable to mechanical ventilation because “the lungs of one man may bear, without injury, as great a force as those of another man can exert which by the bellows cannot always be determined”. The potential for mechanical ventilation to cause harm was first described in the mid-18 th century. As with most medical and pharmacological interventions, mechanical ventilation must be titrated within a therapeutic window, providing the required life-sustaining support while minimizing unintended toxicity.
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