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Ventilator-Induced Lung Injury and Lung Protective Ventilation

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Mechanical Ventilation from Pathophysiology to Clinical Evidence

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Abstract

Lung cells react to forces applied during mechanical ventilation by activating a large variety of biological responses, from proliferation to inflammation or cell death. In heterogeneous lungs, regional volumes and pressures are unevenly distributed, enhancing these mechanosensitive cell responses and causing tissue damage. Inflammation, apoptosis, and matrix remodeling are hallmarks of this condition, termed Ventilator-Induced Lung Injury (VILI). Limitation of VILI is a major goal in the current critical care, but there is no gold standard for its monitoring. As no pharmacological treatment has shown a clinical benefit, optimization of mechanical ventilation remains the only available approach in critically ill patients. Protective ventilatory strategies limit tidal volumes to avoid overdistension and apply positive end-expiratory pressure to ensure a lung rest volume that guarantees gas exchange and minimizes cyclic changes in aeration. However, only reduction of tidal volume in patients with previous lung injury has shown a significant reduction in mortality. Improvements in monitoring and patient selection can help to personalize ventilatory therapy to avoid further lung damage caused by mechanical ventilation.

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Authors and Affiliations

  1. Unidad de Cuidados Intensivos Cardiológicos, Hospital Universitario Central de Asturias, Oviedo, Spain

    Guillermo M. Albaiceta & Laura Amado-Rodríguez

  2. Departamento de Biología Funcional, Instituto Universitario de Oncología del Principado de Asturias. Universidad de Oviedo, Oviedo, Spain

    Guillermo M. Albaiceta

  3. Instituto de Investigación Sanitaria del Principado de Asturias, Oviedo, Spain

    Guillermo M. Albaiceta & Laura Amado-Rodríguez

  4. Centro de Investigación Biomédica en Red-Enfermedades Respiratorias, Madrid, Spain

    Guillermo M. Albaiceta & Laura Amado-Rodríguez

  5. Departamento de Medicina, Instituto Universitario de Oncología del Principado de Asturias, Universidad de Oviedo, Oviedo, Spain

    Laura Amado-Rodríguez

Authors
  1. Guillermo M. Albaiceta
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  2. Laura Amado-Rodríguez
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Correspondence to Guillermo M. Albaiceta .

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Editors and Affiliations

  1. School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy

    Giacomo Bellani

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Albaiceta, G.M., Amado-Rodríguez, L. (2022). Ventilator-Induced Lung Injury and Lung Protective Ventilation. In: Bellani, G. (eds) Mechanical Ventilation from Pathophysiology to Clinical Evidence. Springer, Cham. https://doi.org/10.1007/978-3-030-93401-9_15

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  • DOI: https://doi.org/10.1007/978-3-030-93401-9_15

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  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-030-93400-2

  • Online ISBN: 978-3-030-93401-9

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