Lung protective ventilation such as the ARDSnet low tidal volumes strategy can reduce mortality in ARDS patients. The lmowledge that an essential therapy such as mechanical ventilation on the intensive care influences patient outcome has given rise to the re-evaluation of current ventilation practices. This review addresses the current state of lung protective strategies and their physiological rationale. Latest knowledge on the instigation and progression of lung injury by mechanical ventilation is explored, particularly the interaction between ventilation and the inflammatmy response occun·ing in an ARDS lung. Furthennore, the role of tidal volume, PEEP, recruitment maneuvers and surfactant on lung injury is discussed. Finally, we discuss results from clinical studies on mechanical ventilation and elucidate these results with data acquired in experimental studies. Guidelines for future strategies and/or investigations are presented.

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The studies presented in this thesis were financially supported by the International Foundation for Clinically Oriented Research (IFCOR). Additional financial support for printing was received from: Instrumentation Laboratory (Netherlands) B.V.; Leo Phannaceutical Products.
B.F. Lachmann (Burkhard)
Erasmus University Rotterdam
Erasmus MC: University Medical Center Rotterdam

Haitsma, J. (2002, December 18). Ventilator-induced mediator release: role of PEEP and surfactant. Retrieved from