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초록

Ventilator-induced lung injury (VILI) is the additional inflammatory damage caused by mechanical ventilation, especially inacute respiratory distress syndrome (ARDS). VILI can induce a systematic inflammatory response, resulting in multiple organdysfunction syndrome, which is the major cause of death in ARDS patients. The two main mechanisms of VILI are physical stretchinjury caused by a high tidal volume and shearing force caused by the reopening and collapse of alveoli in atelectatic lung. Protective ventilation strategies to prevent VILI include low tidal volume ventilation, high positive end-expiratory pressure, proneposition ventilation, the alveolar recruitment maneuver, and extracorporeal membrane oxygenation. The clinical support isstrongest for low tidal volume ventilation, which should be used in all cases of ARDS. However, its effectiveness might be limitedbecause of the severe spatial heterogeneity of the lung involvement, which cannot completely prevent regional alveolar distension. Although there is insufficient clinical evidence supporting the other strategies, and they are controversial, various strategies otherthan low tidal volume ventilation should be considered in selected clinical conditions in which they might be effective.

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