• J J Haitsma, R A Lachmann, and B Lachmann.
• Department of Anesthesiology, Erasmus-MC Faculty, PO Box 1738, 3000 DR Rotterdam, The Netherlands.
• Monaldi Arch Chest Dis. 2003 Apr 1;59(2):108-18.

AbstractLung protective ventilation such as the ARDSnet low tidal volumes strategy can reduce mortality in ARDS patients. The knowledge that an essential therapy such as mechanical ventilation on the intensive care influences patient outcome has given rise to the re-evaluation of current ventilation practices. This review addresses the current state of lung protective strategies and their physiological rationale. Latest knowledge on the instigation and progression of lung injury by mechanical ventilation is explored, particularly the interaction between ventilation and the inflammatory response occurring in an ARDS lung. Furthermore, the role of tidal volume, PEEP, recruitment manoeuvres and surfactant on lung injury is discussed. Finally, we discuss results from clinical studies on mechanical ventilation and elucidate these results with data acquired in experimental studies. Guidelines for future strategies and/or investigations are presented.

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