Respiratory Failure and Mechanical Ventilation

Chapter

Abstract

Acute lung injury develops in response to a variety of pulmonary and extrapulmonary disease processes, ultimately resulting in widespread alveolar-capillary leak with extravasation of protein-rich, non-cardiogenic pulmonary edema. This acute phase leads to atelectasis, consolidation, surfactant degradation, and ultimately decreased lung compliance with progressive hypoxemia. Further progression of lung injury leads to a chronic stage, also known as the fibroproliferative stage, characterized by improvement in compliance despite continued poor lung function. Poor compliance at this stage is due to fibrosis and thickening of the lung interstitium. If the patient survives, the acute and fibroproliferative (chronic) stages, his or her lung function can vary from complete recovery to substantial long-lasting pulmonary functional deficits.

Keywords

Permeability Surfactant Toxicity Dioxide Filtration 

Suggested Reading

  1. Brower RG, Lanken PN, MacIntyre N, Matthay MA, Morris A, Ancukiewicz M, et al. Higher versus lower positive end-expiratory pressures in patients with the acute respiratory distress syndrome; National Heart, Lung, and Blood Institute ARDS Clinical Trials Network. N Engl J Med. 2004;351(4):327–36.CrossRefPubMedGoogle Scholar
  2. Hanson JH, Flori H. Application of the acute respiratory distress syndrome network low-tidal volume strategy to pediatric acute lung injury. Respir Care Clin N Am. 2006;12(3):349–57.PubMedGoogle Scholar
  3. Mols G, Priebe HJ, Guttmann J. Alveolar recruitment in acute lung injury. Br J Anaesth. 2006;96(2):156–66.CrossRefPubMedGoogle Scholar
  4. Priebe GP, Arnold JH. High-frequency oscillatory ventilation in pediatric patients. Respir Care Clin N Am. 2001;7(4):633–45.CrossRefPubMedGoogle Scholar
  5. Slutsky AS. Ventilator-induced lung injury: from barotrauma to biotrauma. Respir Care. 2005;50(5):646–59.PubMedGoogle Scholar
  6. The Acute Respiratory Distress Syndrome Network. Ventilation with lower tidal volumes as compared with traditional tidal volumes for acute lung injury and the acute respiratory distress syndrome. N Engl J Med. 2000;342(18):1301–8.CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2011

Authors and Affiliations

  1. 1.Department of Anesthesiology and Critical CareUniversity of Pennsylvania, Children’s Hospital of PhiladelphiaPhiladelphiaUSA

Personalised recommendations