Skip Navigation

This Article
Right arrow Full Text
Right arrow Full Text (PDF)
Right arrow E-Letters: Submit a response to the article
Right arrow E-letters: View responses
Right arrow Alert me when this article is cited
Right arrow Alert me when E-letters are posted
Right arrow Alert me if a correction is posted
Services
Right arrow Email this article to a friend
Right arrow Similar articles in this journal
Right arrow Similar articles in ISI Web of Science
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Add to My Personal Archive
Right arrow Download to citation manager
Right arrow Search for citing articles in:
ISI Web of Science (12)
Right arrowRequest Permissions
Right arrow Disclaimer
Google Scholar
Right arrow Articles by Moloney, E. D.
Right arrow Articles by Griffiths, M. J. D.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by Moloney, E. D.
Right arrow Articles by Griffiths, M. J. D.
Social Bookmarking
Add to CiteULike   Add to Connotea   Add to Del.icio.us  
What's this?

British Journal of Anaesthesia, 2004, Vol. 92, No. 2 261-270
© 2004 The Board of Management and Trustees of the British Journal of Anaesthesia

Review Article

Protective ventilation of patients with acute respiratory distress syndrome

E. D. Moloney and M. J. D. Griffiths*

Imperial College School of Medicine at the National Heart and Lung Institute, Royal Brompton Hospital, London, UK

*Corresponding author: Adult Intensive Care Unit, Royal Brompton Hospital, Sydney Street, London SW3 6NP, UK. E-mail: m.griffiths@ic.ac.uk

The majority of patients with acute respiratory distress syndrome (ARDS) require mechanical ventilation. This support provides time for the lungs to heal, but the adverse effects of mechanical ventilation significantly influence patient outcome. Traditionally, these were ascribed to mechanical effects, such as haemodynamic compromise from decreased venous return or gross air leaks induced by large transpulmonary pressures. More recently, however, the ARDS Network study has established the clinical importance of lowering the tidal volume to limit overdistension of the lung when ventilating patients with ARDS. This study suggests that ventilator-associated lung injury (VALI) caused by overdistension of the lung contributes to the mortality of patients with ARDS. Moreover, the results from clinical and basic research have revealed more subtle types of VALI, including upregulation of the inflammatory response in the injured and overdistended lung. This not only damages the lung, but the overflow of inflammatory mediators into the systemic circulation may explain why most patients who die with ARDS succumb to multi-organ failure rather than respiratory failure. The results of these studies, the present understanding of the pathophysiology of VALI, and protective ventilatory strategies are reviewed.

Br J Anaesth 2004; 92: 261–70


Add to CiteULike CiteULike   Add to Connotea Connotea   Add to Del.icio.us Del.icio.us    What's this?


This article has been cited by other articles:


Home page
 TraumaHome page
P. J Shirley
Trauma and critical care III: chest trauma
Trauma, July 1, 2005; 7(3): 133 - 142.
[Abstract] [PDF]

Home page
 NEJMHome page
B. D. Medoff, J.-A. O. Shepard, R. N. Smith, and A. Kratz
Case 17-2005 - A 22-Year-Old Woman with Back and Leg Pain and Respiratory Failure
N. Engl. J. Med., June 9, 2005; 352(23): 2425 - 2434.
[Full Text] [PDF]

Home page
 Br J AnaesthHome page
R. Baba, K. Paramesh, J. W. Zwaal, M. Griffiths, and E. Moloney
Protective ventilation of patients with acute respiratory distress syndrome
Br. J. Anaesth., July 1, 2004; 93(1): 153 - 153.
[Full Text] [PDF]

Home page
 Br J AnaesthHome page
N. George, M. Griffiths, and E. Moloney
Protective ventilation of patients with ARDS
Br. J. Anaesth., June 1, 2004; 92(6): 906 - 907.
[Full Text] [PDF]

E-letters:

Read all E-letters

Permissive Hypoxemia in ARDS – Is There a Place for a New Strategy?
Mohamad Abdelsalam Abdelkader
British Journal of Anaesthesia, 29 Dec 2004 [Full text]

Disclaimer:
Please note that abstracts for content published before 1996 were created through digital scanning and may therefore not exactly replicate the text of the original print issues. All efforts have been made to ensure accuracy, but the Publisher will not be held responsible for any remaining inaccuracies. If you require any further clarification, please contact our Customer Services Department.