Ventilator Associated Lung Injury

by Dr Chris Nickson, last update March 30, 2019

OVERVIEW

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:

volutramua

barotrauma

biotrauma

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

LITFL

CCC — Volutrauma

CCC — Protective lung ventilation

CCC — Open Lung Approach to Ventilation

Journal articles

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.

https://litfl.com/ventilator-associated-lung-injury/