RT Book, Section A1 Dreyfuss, Didier A1 Prost, Nicolas de A1 Ricard, Jean-Damien A1 Saumon, Georges A2 Tobin, Martin J. SR Print(0) ID 57074964 T1 Chapter 42. Ventilator-Induced Lung Injury T2 Principles and Practice of Mechanical Ventilation, 3e YR 2013 FD 2013 PB The McGraw-Hill Companies PP New York, NY SN 978-0-07-173626-8 LK accessmedicine.mhmedical.com/content.aspx?aid=57074964 RD 2024/10/11 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