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Principles of Critical Care, 3e
Part IV. Pulmonary Disorders
Chapter 37. Ventilator-Induced Lung Injury
John T. Granton, Arthur S. Slutsky
lung injury, ventilator-associated.
There is consistent and convincing experimental evidence that mechanical ventilation, particularly in the setting of lung injury, can contribute to functional and structural alterations in the lung. The experimental evidence has led to the notion that mechanical ventilation not only perpetuates the lung injury, but also contributes to both the morbidity and mortality of the acute respiratory distress syndrome (ARDS). Concern surrounding ventilator-induced lung injury (VILI) culminated in a consensus conference in 1993 that made (based solely on studies in animal models of ARDS) the empirical recommendation to limit tidal volumes to the range of 5 to 7 mL/kg and plateau pressures less than 35 cm H
It would be 8 years until the recommendations of the consensus group were affirmed by a randomized controlled trial demonstrating that a lung-protective strategy designed to limit VILI would lead to an improvement in patient outcome.
Unfortunately, it seems that it may take even longer until there is incorporation of these concepts into widespread clinical practice.
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