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Rivista di Anestesia, Rianimazione, Terapia Antalgica e Terapia Intensiva
Minerva Anestesiologica 2012 Settembre;78(9):1054-66
How to prevent ventilator-induced lung injury?
De Prost N. 1, Dreyfuss D. 2, 3, 4 ✉
1 Assistance Publique, Hôpitaux de Paris, Hôpital Henri Mondor, Service de Réanimation Médicale, Créteil, France;
2 Université Paris-Diderot and PRES Sorbonne Paris Cité, Site Xavier Bichat, Paris, France;
3 Assistance Publique, Hôpitaux de Paris, Hôpital Louis Mourier, Service de Réanimation Médicale, Colombes, France;
4 INSERM U722, Paris, France
The experimental evidence that ventilator could injure lungs through the application of excessive end-inspiratory volumes and transpulmonary pressures has led to major changes in the clinical management of patients suffering from the acute respiratory distress syndrome (ARDS). The prevention of ventilator-induced lung injury has become one of the main goals of current ventilator strategies for patients with ARDS as well as for patients with normal lungs that require mechanical ventilation. Tidal volume reduction allowed for a reduction in mortality that confirmed the clinical relevance of ventilator-induced lung injury. In contrast, strategies for setting positive end-expiratory pressure (PEEP) have been proposed but the optimal PEEP level remains unsettled. Considerable efforts have been made within the last decades to try to develop new ventilator strategies as well as pharmacological and mechanical measures in order to prevent VILI and further improve the outcome of ARDS patients. This review will strive to describe seminal experimental and clinical studies that aimed at preventing the development of VILI.