Lung Distention, Barotrauma and Mechanical Ventilation

  • M. R. Pinsky
Conference paper


Mechanical ventilation usually entails the application of varying amounts of positive airway pressure in a cyclic fashion to force tidal breaths into the lungs and maintain distending pressure. The addition of supplemental O2 to enrich the ventilating gas is universal, and is itself a separate factor of artificial ventilation. Positive-pressure ventilation supplies a force necessary to overcome elastic and resistive forces of the entire ventilatory apparatus. Only a portion of this force is actually directed at alveolar distention, and in subjects with severe bronchospasm or asynchrony of spontaneous ventilatory efforts with those of the ventilator, very little of the distended pressure may be sensed by the alveoli. However, if positive-pressure ventilation grossly overdistends the alveoli even once or induces repetitive degrees of lesser overdistention of the lungs because either the overall tidal volume is too high or the distribution of the delivered gas is such that only certain regions of the lung are distended, then alveolar injury may occur. These injuries are collectively referred to as barotrauma. Such injury actually reflects over-distention of the alveoli rather than over-pressure of the airways. Accordingly, the term “volutrauma” has been suggested to reflect this process [1]. Although overdistention of the lung at end-inspiration is a major cause of barotrauma, changes in end-expiratory volume also play a major role, especially if fixed tidal volumes are used to ventilate a subject.


Continuous Positive Airway Pressure Tidal Volume Acute Lung Injury Airway Pressure Functional Residual Capacity 
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© Springer-Verlag Italia 1997

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  • M. R. Pinsky

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