TY - CHAP M1 - Book, Section TI - Chapter 42. Ventilator-Induced Lung Injury A1 - Dreyfuss, Didier A1 - Prost, Nicolas de A1 - Ricard, Jean-Damien A1 - Saumon, Georges A2 - Tobin, Martin J. PY - 2013 T2 - Principles and Practice of Mechanical Ventilation, 3e AB - The deleterious effects of mechanical ventilation on the lungs have long been referred to as barotrauma. For many years, clinicians defined barotrauma as the occurrence of air leaks resulting in the accumulation of extraalveolar air responsible for a number of manifestations, of which the most threatening is tension pneumothorax. In addition to these “macroscopic” events whose adverse consequences are usually immediately obvious, mechanical ventilation may produce more subtle physiologic and morphologic alterations, especially when it results in high airway pressures. Our knowledge of such alterations has stemmed mainly from experimental studies and has expanded considerably over recent years. Indeed, alterations in alveolar–capillary barrier integrity and release of both inflammatory and antiinflammatory mediators have been reported in animals ventilated with modalities resulting in high lung stretching. Tissue damage also may occur during mechanical ventilation when distal airways close and open repeatedly because of the movement of foam in the airway lumen or rupture of liquid menisci. The clinical relevance of these experimental findings received resounding confirmation with the results of the ARDS Network study, which showed a 22% reduction in mortality in patients with the acute respiratory distress syndrome through a simple reduction in tidal volume.1 SN - PB - The McGraw-Hill Companies CY - New York, NY Y2 - 2024/10/13 UR - accessmedicine.mhmedical.com/content.aspx?aid=57074964 ER -