Lung protective ventilation strategies

While traditional ventilation approaches are appropriate for the patient without significant lung disease and only requiring short-term mechanical ventilatory support, the strategy should be altered for the patient with severe lung disease. Research on the mechanisms of ventilator-induced lung injury has led to the development of mechanical ventilation strategies that improve patient outcomes. The trend toward using lower tidal volumes, limited airway pressures, and PEEP have produced improved outcome results. Predictive indices of outcome using laboratory values, biologic markers, and mediators of lung injury are being evaluated for early identification of patients at risk for lung injury. Nonconventional ventilatory approaches, such as noninvasive positive pressure ventilation and high frequency ventilation, as well as adjunctive therapies (inhaled nitric oxide and extracorporeal circulation) are being explored as alternatives in ARDS and ALI. While more clinical studies outline outcomes in specific subgroups of patients, the ventilatory strategy should continually be revised at the bedside.