Mechanical ventilation with application of pressure to the lung, whether positive or negative, can cause damage known as ventilator-associated lung injury (VALI)
- VALI may occur in previously normal lungs or worsen pre-existing ARDS
- About 1 in 4 mechanically ventilated patients develop VALI, the risk is likely higher in ARDS patients
- Ventilator induced lung injury (VILI) is sometimes used as a synonym for VALI, but strictly speaking VILI is VALI when mechanical ventilation is the proven cause of lung injury
TYPES OF VALI
Ventilator Associated Lung Injury (VALI) can occur due to:
- recruitment/ derecruitment injury (atelectotrauma)
- shearing injury
- oxygen toxicity
Ventilated patients are also at risk of ventilator associated pneumonia (VAP)
MECHANISMS AND MINIMISATION STRATEGIES
References and Links
- Frank JA, Matthay MA. Science review: mechanisms of ventilator-induced injury. Crit Care. 2003 Jun;7(3):233-41. PMC270664.
- Gajic O, Dara SI, Mendez JL, Adesanya AO, Festic E, Caples SM, Rana R, St Sauver JL, Lymp JF, Afessa B, Hubmayr RD. Ventilator-associated lung injury in patients without acute lung injury at the onset of mechanical ventilation. Crit Care Med. 2004 Sep;32(9):1817-24. PMID: 15343007.
- Mead J, Takishima T, Leith D. Stress distribution in lungs: a model of pulmonary elasticity. J Appl Physiol. 1970;28:596–608. [PubMed]
- Pinhu L, Whitehead T, Evans T, Griffiths M. Ventilator-associated lung injury. Lancet. 2003 Jan 25;361(9354):332-40. PMID: 12559881
- Rocco PR, Dos Santos C, Pelosi P. Pathophysiology of ventilator-associated lung injury. Curr Opin Anaesthesiol. 2012 Apr;25(2):123-30. PMID: 22395439.