Lung protective ventilatory strategies in acute lung injury and acute respiratory distress syndrome: from experimental findings to clinical application

• Published in: Clinical physiology and functional imaging Vol. 27; no. 2; pp. 67 - 90
• Main Authors: Verbrugge, Serge J. C., Lachmann, Burkhard, Kesecioglu, Jozef
• Format: Journal Article
• Language: English
• Published: Oxford, UK Blackwell Publishing Ltd 01.03.2007; Blackwell Science
• Subjects: Animals; Biological and medical sciences; Capillary Permeability; Clinical Trials as Topic - methods; Critical Care; Disease Progression; Endotoxemia - etiology; Endotoxemia - prevention & control; Fundamental and applied biological sciences. Psychology; haemodynamics; Humans; Inflammation Mediators - metabolism; mechanical ventilation; open lung strategy; Patient Selection; positive end-expiratory pressure; Positive-Pressure Respiration - adverse effects; Practice Guidelines as Topic; Pulmonary Alveoli - blood supply; Pulmonary Alveoli - physiopathology; Pulmonary Circulation; Pulmonary Edema - etiology; Pulmonary Edema - prevention & control; Pulmonary Surfactants - metabolism; Research Design; Respiration, Artificial - adverse effects; Respiratory Distress Syndrome, Adult - complications; Respiratory Distress Syndrome, Adult - etiology; Respiratory Distress Syndrome, Adult - physiopathology; Respiratory Distress Syndrome, Adult - therapy; Tidal Volume; ventilator-induced lung injury; Vertebrates: anatomy and physiology, studies on body, several organs or systems; Lung disease; Acute lung injury; Ventilator; Respiratory disease; tida] volume; Vertebrata; Mammalia; Positive pressure; Respiratory distress; positive end-expirutory pressure; ventilator-induced lung injury; Mechanical ventilation; haemodynamics; open lung strategy
• ISSN: 1475-0961; 1475-097X
• DOI: 10.1111/j.1475-097X.2007.00722.x

Summary This review addresses the physiological background and the current status of evidence regarding ventilator‐induced lung injury and lung protective strategies. Lung protective ventilatory strategies have been shown to reduce mortality from adult respiratory distress syndrome (ARDS). We review the latest knowledge on the progression of lung injury by mechanical ventilation and correlate the findings of experimental work with results from clinical studies. We describe the experimental and clinical evidence of the effect of lung protective ventilatory strategies and open lung strategies on the progression of lung injury and current controversies surrounding these subjects. We describe a rational strategy, the open lung strategy, to accomplish an open lung, which may further prevent injury caused by mechanical ventilation. Finally, the clinician is offered directions on lung protective ventilation in the early phase of ARDS which can be applied on the intensive care unit.