Ventilator-Induced Lung Injury PDF

Preface

Few experimental findings have so sharply influenced the care of critically ill patients as has been the case with ventilator-induced lung injury. This breakthrough stemmed from a conceptual and experimental effort, stimulated by the need for improving the dismal prognosis of acute respiratory distress syndrome. One must remember the fatality rate of more than 90% (1) in initial clinical series and compare it with the 31% mortality rate observed with a lung protective strategy in the recent study from the Acute Respiratory Distress Syndrome Network (2) to realize the importance of the prognostic progress fostered by these experimental studies.

The pioneering study was published by Webb and Tierney (3), who showed that high peak airway pressure ventilation of intact rats provokes pulmonary edema. The lung lesions produced by this ventilation closely mimic those observed during acute respiratory distress syndrome (4,5). In other words, mechanical ventilators are potentially able to generate the disease they are supposed to support. Mead and coworkers (6), based on theoretical considerations, stressed that applying high pulmonary transmural pressure by ventilators to unevenly expanded lungs might cause hemorrhages in hyaline membranes, only several years after the initial description of acute respiratory distress syndrome (7).

This book aims to describe the different steps of basic research that allowed the comprehension of ventilator-induced lung injury, their clinical consequences, and the new avenues of basic research that again emerged. Studies on mechanical transduction, lung mechanics, and endothelial and epithelial physiology formed the cornerstone of this better comprehension. This knowledge stimulated clinical research for designing safer ventilator studies, with overwhelming success for some strategies and persisting questions for others. Finally, new research efforts on the biology of inflammatory mediators during ventilator-induced lung injury and on gene therapy during acute lung injury set hope for further improvement of the prognosis for acute respiratory distress syndrome.

It was both a privilege and a pleasure for the three editors of this book to ask for the contributions of recognized experts in this field, and we wish to express our gratitude for their outstanding chapters, which will undoubtedly make this book a success.