Toward a better ventilation strategy for patients with acute lung injury 英文参考文献.docVIP

/content/4/4/205 Commentary Toward a better ventilation strategy for patients with acute lung injury Michael R Pinsky Anesthesiology and Critical Care Medicine, Pittsburgh, Pennsylvania, USA Received: 17 May 2000 Accepted: 31 May 2000 Published: 3 July 2000 Crit Care 2000,4:205–206 ? Current Science Ltd Abstract Ventilator-induced lung injury is a major outcome determinant of the acute respiratory distress syndrome (ARDS). Ventilatory strategies that limit ventilator-induced lung injury should improve outcome from ARDS. The ARDSnet trial showed improved survival in subjects ventilated with a lower tidal volume. Although this trial developed and tested a rigorous clinical protocol, it did not define the limits to which tidal volume reduction would benefit outcome. It is also not at all clear if it is the reduction in tidal volume or the reduction in plateau airway pressure that confers this benefit. Finally, ventilator-induced lung injury occurs more commonly from repetitive collapse and re-expansion of injured lung units rather than from the overdistention of persistently aerated lung units. This was not addressed in the trial design. Thus, further study using targeted open-lung strategies are also needed. Keywords: ARDS, outcome, ventilation, ventilator-induced lung injury The ARDS has been with us as a known entity for over 40 years. It was originally referred to as noncardiogenic pulmonary edema. Although originally thought of as a process of direct alveolar epithelial injury, it is now widely appreciated that almost any insult to the lungs or body can result in ARDS through blood-borne mediators. Inherent in this concept is the realization that ARDS is often part of a systemic inflammatory process. Accordingly, lung-specific therapies, such as mechanical ventilation, if they induce further lung injury, can sustain or promote further lung injury and remote