• Bhushan H Katira.
• Translational Medicine, The Research Institute, Hospital for Sick Children, Toronto, Ontario, Canada; Department of Critical Care Medicine, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada; and Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Ontario, Canada. bhushan.katira@sickkids.ca.
• Respir Care. 2019 Jun 1; 64 (6): 629-637.

AbstractVentilator-induced lung injury (VILI) is a central confounder to improving outcomes from use of positive-pressure ventilation in critical illness. Therefore, with increasing use of positive-pressure ventilation, awareness to prevent VILI has grown. Because VILI cannot be diagnosed at the bedside, its prevention can only be attained by identifying the clinical mechanisms of harm, such as high tidal volume, high plateau pressure, and so forth, which, in turn, are derived from decades of laboratory work. The practice of positive-pressure ventilation has undergone a significant change; most important in the past decade is the preference to use noninvasive ventilation. Although noninvasive ventilation prevents the complications of intubation, it has potential to cause harm, especially in patients with de novo respiratory failure. This review covers some of the classic and emerging concepts of VILI genesis and their role during noninvasive ventilation. Combined modulation of these mechanisms could have a potential to impact outcomes.Copyright © 2019 by Daedalus Enterprises.

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