• Liliane M Nardelli, Cristiane S N B Garcia, Caroline P Pássaro, and Patricia R M Rocco.
• Laboratório de Investigação Pulmonar, Instituto de Biofísica Carlos Chagas Filho, UFRJ.
• Rev Bras Ter Intensiva. 2007 Dec 1;19(4):469-74.

Background And ObjectivesMechanical ventilation is considered a basic element of life support in the intensive care unit and is essential for patients with acute lung injury (ALI) and acute respiratory distress syndrome (ARDS). Experimental studies have demonstrated that mechanical ventilation with high volumes and/or high pressures can exacerbate (VALI) or induce lung injury (VILI) with histological aspect similar to ALI/ARDS.ContentsThis systematic review included the literature on MedLine and SciElo database published in the last 20 years. In this review, we will highlight the most recent data on the mechanisms of VILI. The main mechanisms of VILI are: volutrauma caused by overinflation and uneven expansion of the lungs due to high ventilation pressures or volumes; aletectrauma induced by shear forces generated during cyclic closure and reopening of terminal airways; and biotrauma where the injury resulted from the release inflammatory mediators due to physical stresses associated with mechanical ventilation.ConclusionsIt is fundamental to understand the mechanisms related to volutrauma, atelectrauma, and biotrauma to avoid ventilator-associated lung injury.

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