Monitoring Lung-protective Ventilation

Abstract Summary Lung-protective ventilation strategies have been developed to reduce ventilator-associated lung tissue injury and simultaneously improve systemic oxygenation. We now know that mechanical ventilation per se can aggravate lung injury, a process referred to as ‘ventilator-induced lung injury’ (VILI), through several mechanisms, including volutrauma, barotrauma, and biotrauma. Lung-protective ventilation regulates positive end-expiratory pressure (PEEP), maintains a greater number of pulmonary alveoli in an open state, and avoids excessive end-expiratory lung volume and mechanical power while maintaining an adequate tidal volume and minute ventilation. Moreover, in preventing the collapse of open pulmonary alveoli, PEEP not only helps maintain production and function of pulmonary surfactants but also reduces the shear stress. Current research suggests that reduction of ventilator-associated lung injury or VILI is a main avenue for further reducing mortality in this syndrome. In this chapter, we offer a review of the current literature regarding the use of transpulmonary pressure (Ptp), driving pressure, mechanical power, and stress index in reducing the risk of VILI.