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Korean J Med > Volume 86(5); 2014 > Article
The Korean Journal of Medicine 2014;86(5): 529-536.
기계환기로 인한 폐손상
김제형
고려대학교 안산병원 호흡기내과
Ventilator-Induced Lung Injury
Je Hyeong Kim
Division of Pulmonary, Sleep and Critical Care Medicine, Department of Internal Medicine, Korea University Ansan Hospital, Ansan, Korea
Corresponding Author: Je Hyeong Kim ,Tel: +82-31-412-5950, Fax: +82-31-413-5950, Email: chepraxis@korea.ac.kr
This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted noncommercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
ABSTRACT
Ventilator-induced lung injury (VILI) is the additional inflammatory damage caused by mechanical ventilation, especially in acute respiratory distress syndrome (ARDS). VILI can induce a systematic inflammatory response, resulting in multiple organ dysfunction syndrome, which is the major cause of death in ARDS patients. The two main mechanisms of VILI are physical stretch injury caused by a high tidal volume and shearing force caused by the reopening and collapse of alveoli in atelectatic lung. Protective ventilation strategies to prevent VILI include low tidal volume ventilation, high positive end-expiratory pressure, prone position ventilation, the alveolar recruitment maneuver, and extracorporeal membrane oxygenation. The clinical support is strongest for low tidal volume ventilation, which should be used in all cases of ARDS. However, its effectiveness might be limited because of the severe spatial heterogeneity of the lung involvement, which cannot completely prevent regional alveolar distension. Although there is insufficient clinical evidence supporting the other strategies, and they are controversial, various strategies other than low tidal volume ventilation should be considered in selected clinical conditions in which they might be effective. (Korean J Med 2014;86:529-536)
Keywords: Acute respiratory distress syndrome; Mechanical ventilation; Ventilator-induced lung injury
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