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Low versus High Tidal Volumes

  • Conference paper
Acute Lung Injury

Part of the book series: Update in Intensive Care and Emergency Medicine ((UICM,volume 30))

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Abstract

In the last 5 to 10 years, considerable attention has been paid to the ventilatory strategies used in the acute respiratory distress syndrome (ARDS) because ventilation could act not only as a symptomactic support but could also have an important impact on lung injury itself. Two general ideas are supporting this view. The first one is that mechanical ventilation by itself has the potential to induce lethal lesions of the alveolo-capillary membrane [1]. The severe evolution of some patients ventilated in the intensive care unit could be a result of inappropriate ventilatory settings. Up to now, it is extremely difficult to apply the experimental findings of different animal models to patients. Results are so impressive, however, that this concern became rapidly a rule and deliberate reduction in pressure or volume have been proposed as almost mandatory settings [2]. The second concern is the necessity to open up the collapsed zones of the lung and to keep them open [3]. The ventilatory settings producing these effects and enhancing what is referred to as alveolar recruitment, have been studied in details in patients by means of computed tomography (CT) scan [4–6]. Keeping the lung open necessitates to maintain a positive end-expiratory pressure (PEEP) which, in addition to obvious symptomatic improvement in oxygenation, has been found to be potentially important for the evolution of the disease in animal studies [7,8]. One of the important aspect seems to avoid the opening collapse phenomenon which necessarily occurs when the lung is allowed to collapse at end expiration [9,10].

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Authors
  1. L. Brochard
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Editors and Affiliations

  1. Pulmonary and Critical Care, St. Paul Ramsey Medical Center, 640 Jackson Street, St. Paul, 55101, MN, USA

    John J. Marini

  2. Anaesthesia and Critical Care, Royal Brompton Hospital, Sydney Street, SW3 6NP, London, UK

    Timothy W. Evans

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© 1998 Springer-Verlag Berlin Heidelberg

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Brochard, L. (1998). Low versus High Tidal Volumes. In: Marini, J.J., Evans, T.W. (eds) Acute Lung Injury. Update in Intensive Care and Emergency Medicine, vol 30. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-642-60733-2_17

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  • DOI: https://doi.org/10.1007/978-3-642-60733-2_17

  • Publisher Name: Springer, Berlin, Heidelberg

  • Print ISBN: 978-3-642-64532-7

  • Online ISBN: 978-3-642-60733-2

  • eBook Packages: Springer Book Archive

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