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Semin Respir Crit Care Med 2006; 27(4): 396-403
DOI: 10.1055/s-2006-948293
Copyright © 2006 by Thieme Medical Publishers, Inc., 333 Seventh Avenue, New York, NY 10001, USA.

Ventilatory Management of ALI/ARDS

Neil MacIntyre1
  • 1Division of Pulmonary, Allergy, and Critical Care, Duke University Medical Center, Durham, North Carolina
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Publication History

Publication Date:
14 August 2006 (online)

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ABSTRACT

Acute lung injury (ALI) and the acute respiratory distress syndrome (ARDS) describe syndromes of diffuse parenchymal lung injury resulting from a variety of inflammatory triggers. The pathophysiological consequences include stiff, low-compliance lungs with impaired gas exchange. Importantly, there is often marked heterogeneity of disease. Positive pressure ventilation must therefore not only focus on recruiting and ventilating diseased units but must also avoid injuring healthy units. To this end, the goals of mechanical ventilatory support of ALI and ARDS have shifted over the last decade to providing smaller (and thus less injurious) tidal volumes and accepting consequently lower arterial values for PaO2 and the development of respiratory acidosis. This has resulted in significant improvements in outcomes. Future developments will need to further refine this lung protective concept.

KEYWORDS

Ventilator-induced lung injury - lung protection - gas exchange - respiratory system mechanics

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Neil MacIntyreM.D. 

Pulmonary, Allergy, and Critical Care, Duke University Medical Center

DUMC 3911, Durham, NC 27710

Email: neil.macintyre@duke.edu