ABSTRACT
Mechanical ventilation is life sustaining and is the standard therapy for acute respiratory
failure. The 16th century anatomist Vesalius is often credited for the earliest account
of positive-pressure ventilation. In his work De humani corporis fabrica (On the Fabric of the Human Body), he described how an animal could be resuscitated
by blowing into a reed inserted into a hole in its trachea.[1] Although positive pressure ventilation using bellows was first used for drowning
victims in the 1700s, there were soon concerns that such therapy could in fact be
harmful to the lungs.[2] In 1827, Leroy d'Etoille condemned bellows ventilation after discovering that it
could lead to emphysema and tension pneumothoraces. Subsequently, positive pressure
ventilation would be virtually abandoned for over 100 years.[2]
Despite this early concern about the potential for harm from mechanical ventilation,
it is only in the last one to two decades that research into so-called ventilator-induced
lung injury (VILI) has blossomed. Indeed, although initial studies have focused on
which ventilatory parameters are associated with the most (or least) harm, there has
been an explosion of research in the last 5 years attempting to delineate the basic
cellular mechanisms by which mechanical ventilation injures the lung. Recently, there
has been exciting evidence to suggest that lung injury induced by mechanical ventilation
may have important systemic consequences, including multi-organ dysfunction.[3] Lastly and most importantly, there is accumulating data from clinical trials in
humans that ventilatory strategies designed to avoid VILI can in fact save lives.
KEYWORD
Ventilator-induced lung injury - volutrauma - atelectasis - recruitment-derecruitment
- pressure-volume curve - barotrauma - biotrauma
