Determinants and Prevention of Ventilator-Induced Lung Injury

Crit Care Clin. 2018 Jul;34(3):343-356. doi: 10.1016/j.ccc.2018.03.004.


Ventilator-induced lung injury develops from interactions between the lung parenchyma and applied mechanical power. In acute respiratory distress syndrome, the lung is smaller size with an inhomogeneous structure. The same mechanical force applied on a reduced parenchyma would produce volutrauma; the concentration of mechanical forces at inhomogeneous interfaces produces atelectrauma. Higher positive end-expiratory pressures favor volutrauma and reduce atelectrauma; lower values do the opposite. Volutrauma and atelectrauma harms and benefits, however, seem to be equivalent at 5 to 15 cm H2O. At values greater than 15 cm H2O, the risk of damage outweighs the benefits of major atelectrauma prevention.

Keywords: Acute respiratory distress syndrome; High-volume and high-pressure ventilation; Mechanical power; Mechanical ventilation; Ventilator-induced lung injury.

Publication types

  • Review

MeSH terms

  • Air Pressure
  • Functional Residual Capacity
  • Humans
  • Lung Compliance*
  • Lung Volume Measurements
  • Respiration, Artificial / adverse effects*
  • Respiration, Artificial / methods*
  • Respiratory Distress Syndrome / physiopathology
  • Respiratory Distress Syndrome / therapy
  • Respiratory Mechanics
  • Ventilator-Induced Lung Injury / etiology*
  • Ventilator-Induced Lung Injury / mortality
  • Ventilator-Induced Lung Injury / physiopathology*
  • Ventilator-Induced Lung Injury / prevention & control