The adverse effects of mechanical ventilation in acute respiratory distress syndrome (ARDS) arise from two main causes: unphysiological increases of transpulmonary pressure and unphysiological increases/decreases of pleural pressure during positive or negative pressure ventilation. To minimize adverse interactions between lung pathology and ventilatory settings that promote VILI requires two distinct strategies: on one side, decreasing the inspiratory (and possibly the expiratory) mechanical power and damaging strain should decrease VILI; and on the other, steps to increase lung homogeneity should decrease the likelihood of injury.

Read More