Ventilator-induced lung injury, cytokines, PEEP, and mortality: Implications for practice and for clinical trials

Abstract

A mainstay in the supportive care of patients with acute lung injury (ALI)/acute respiratory distress syndrome (ARDS) is mechanical ventilation. However, a number of animal and clinical studies have demonstrated that mechanical ventilation itself can worsen preexisting lung injury and produce ventilator-induced lung injury (VILI). Although the most obvious clinical abnormalities of ALI/ARDS are related to lung function, the most common cause of death is dysfunction of other organs, termed multiple organ dysfunction syndrome (MODS) [1], which is commonly accompanied by the systemic inflammatory response syndrome (SIRS). SIRS/MODS is a complex syndrome, often precipitated and intensified by a series of events rather than a single event. Recent clinical trials have demonstrated that in patients with ARDS, protective ventilatory strategies are associated with decreased serum cytokine levels [2, 3], decreased levels of organ dysfunction [3, 4], and decreased mortality [3, 5], perhaps by partially mitigating the development of MODS [6].