《Ventilator-Induced Lung Injury》.pdfVIP

T h e n e w e ngl a nd j o u r na l o f m e dic i n e review article Critical Care Medicine Simon R. Finfer, M.D., and Jean-Louis Vincent, M.D., Ph.D., Editors Ventilator-Induced Lung Injury Arthur S. Slutsky, M.D., and V. Marco Ranieri, M.D. From the Keenan Research Center, Li Ka he purpose of mechanical ventilation is to rest the respiratory Shing Knowledge Institute, St. Michael’s muscles while providing adequate gas exchange. Ventilatory support proved Hospital, and the Department of Medi- Tto be indispensable during the 1952 polio epidemic in Copenhagen, decreasing cine and Interdepartmental Division of Critical Care Medicine, University of To- mortality among patients with paralytic polio from more than 80% to approximately ronto — both in Toronto (A.S.S.); and 1 40%. Despite the clear benefits of this therapy, many patients eventually die after Dipartimento di Anestesia e Medicina degli Stati Critici, Ospedale S. Giovanni the initiation of mechanical ventilation, even though their arterial blood gases may Battista Molinette, Università di Torino, have normalized. Turin, Italy (V.M.R.). Address reprint re- This mortality has been ascribed to multiple factors, including complications quests to Dr. Slutsky at St. Michael’s Hos- pital, 30 Bond St., Toronto, ON M5B 1W8, of ventilation such as barotrauma (i.e., gross air leaks), oxygen toxicity, and hemo- Canada, or at slutskya@smh.ca. dynamic compromise.2,3 During the p