Similarly, animal models in which a cuirass is used to bind the thoracic cavity and limit lung volumes demonstrated that pressure alone did not lead to significant lung injury, but rather large volume changes led to lung injury. Volutrauma : One of the landmark ARDSnet trials compared 6 cc/kg tidal volume with 12 cc/kg tidal volume and demonstrated improved mortality with lower tidal volume (31 vs 40%, respectively). peak pressures which are determined both by lung compliance and airway resistance) goals are <30 cm H20. In general, plateau pressure (what the alveoli sees vs. High FIO2 (generally thought of as >50-60%) contribute to reactive oxygen species and free radical production which can contribute to lung injuryĬellular Biotrauma describes the upregulation of the inflammatory response as a result to the mechanical forces imposed by mechanical ventilationīarotrauma as a result of excessive distending pressures. Ventilator induced lung injury also contributes to ongoing lung injury ARDS ( Acute Respiratory Distress Syndrome )Ĭlassically defined as (1994 American European Consensus Conference):įigure 1: Pathophysiology of ARDS (Ware et al, NEJM 2000)
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