MECHANICAL VENTILATION OF PATIENTS WITH ACUTE LUNG INJURY

Ventilatory management of patients with acute lung injury (ALI), parti cularly its most severe subset, acute respiratory distress syndrome (A RDS), is complex. Newer lung protective strategies emphasize measures to enhance alveolar recruitment and avoid alveolar overdistention, thu s minimizing the risk of ventilator-induced lung injury (VILI). Key co mponents of such strategies include the use of smaller-than-convention al tidal volumes which maintain peak transpulmonary pressure below the pressure associated with overdistention, and titration of positive en d-expiratory pressure to promote maximal alveolar recruitment. Novel t echniques, including prone positioning, inverse ratio ventilation, tra cheal gas insufflation, and high frequency ventilation are considerati ons in severe ARDS. No single approach is best for all patients; adjus tment of ventilatory parameters to individual characteristics, such as lung mechanics and gas exchange, is required.