• Users Online: 127
  • Print this page
  • Email this page
REVIEW ARTICLE
Year : 2018  |  Volume : 7  |  Issue : 1  |  Page : 4-13

Strategies to prevent ventilator-associated lung injury in critically Ill patients


1 Department of Anaesthesia and Surgical Intensive Care, Changi General Hospital, Simei, Singapore
2 Department of Anaesthesiology, Aga Khan University, Karachi, Pakistan
3 Department of Medicine, King Abdulaziz Medical City, Ministry of National Guard Health Affairs, Riyadh, Saudi Arabia; Department of Anaesthesia and Intensive Care, Stoke Mandeville Hospital, Aylesbury, UK, UK.

Correspondence Address:
Dr. Rajkumar Rajendram
Department of Anaesthesia and Intensive Care, Stoke Mandeville Hospital, Aylesbury, Buckinghamshire
UK.
Login to access the Email id

Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijrc.ijrc_6_17

Rights and Permissions

Life-saving mechanical ventilation (MV) induces or exacerbates a range of pulmonary pathologies, collectively known as ventilator-induced lung injury if there is evidence of direct causation (i.e., in the research laboratory). However, in clinical practice, the term ventilator-associated lung injury (VALI) is more appropriate. While several factors are involved, the main drivers of the pathogenesis are regional overdistention and clinical atelectasis. This understanding has led to search for strategies to attenuate VALI and improve survival. The current approaches focus on reduction of lung stress and strain by limitation of alveolar–plateau pressure and tidal volume. Recent data suggest that control of driving pressure (plateau pressure–positive end-expiratory pressure) and mechanical power applied during ventilation may also be beneficial. More exciting are the various new techniques for MV (e.g., airway pressure release ventilation and neurally adjusted ventilatory assist), emerging alternative modalities for gas exchange (e.g., extracorporeal membrane oxygenation), and novel biological therapies (e.g., anti-inflammatory stem cells) that promise to revolutionize the management of respiratory failure and relegate VALI to the ash heap of history. However, there are currently insufficient data to recommend their use in routine clinical practice.


[FULL TEXT] [PDF]*
Print this article     Email this article
 Next article
 Previous article
 Table of Contents

 Similar in PUBMED
   Search Pubmed for
   Search in Google Scholar for
 Related articles
 Citation Manager
 Access Statistics
 Reader Comments
 Email Alert *
 Add to My List *
 * Requires registration (Free)
 

 Article Access Statistics
    Viewed550    
    Printed55    
    Emailed0    
    PDF Downloaded137    
    Comments [Add]    

Recommend this journal