Ventilator-associated lung injury

Mechanical ventilation of disease-affected lungs, as well as an inadequate ventilatory mode of initially healthy lungs, can cause significant changes in lung structure and function. To differentiate between these processes, two terms are used: ventilator-associated lung injury (VALI) and ventilator-induced lung injury (VILI). In both cases, lung injury primarily results from the differences in transpulmonary pressure, which is a consequence of imbalance between lung stress and strain. The present study focuses on changes in lung structure and function due to this imbalance. In this context, barotrauma, volutrauma and atelectrauma are interpreted and the importance of signal transduction, which is a process for inducing local and systemic inflammatory responses (biotrauma), is determined. None of the assessed methods for reducing VALI and VILI has been found to be useful; however, studies evaluating oscillatory ventilation, liquid ventilation, early ECMO, super-protective ventilation or noisy ventilation and administration of certain drugs are underway. Low tidal volume ventilation and adequately adjusted PEEP appear to be the best preventive measures for mechanical ventilation in any setting, including the operating theatre. Furthermore, the present study highlights the advances in VILI/VALI prevention, which are derived from a better understanding of pathophysiological phenomena.