Info
Mechanisms of VILI Ventilator Strategies
Barotrauma/volutrauma:
alveolar dist → mech damage VT ≤6 mL/kg, Pplat ≤30 cm H2O, tolerate ↑ PaCO2 (but keep pH >7.2), ↓ mortality (NEJM 2000;342:1301)
Biotrauma →
SIRS Low VT, open lung strategy w/ high PEEP
Atelectrauma: repetitive alveoli recruit & decruit
Titrate PEEP to prevent tidal alveolar collapse See below for options
Hyperoxia: ? injury; worsened V/Q matching
↑ PEEP rather than FiO2 (keep <0.60) O2-induced injury only theoretical in humans