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Optimal ventilator settings in acute lung injury and acute respiratory distress syndrome

Yilmaz, M.*,†; Gajic, O.*

European Journal of Anaesthesiology (EJA): February 2008 - Volume 25 - Issue 2 - p 89–96
doi: 10.1017/S0265021507003006

Despite recent advances in intensive care medicine, acute lung injury and its more severe form, acute respiratory distress syndrome pose major therapeutic problems. While mechanical ventilation is integral to the care of these patients, its adverse consequences including ventilator-induced lung injury are determinants of disease progression and prognosis. Among several important ventilator parameters, the use of low tidal volumes is probably the most important feature of lung-protective mechanical ventilation. Intensivists should be trained to recognize acute lung injury and acute respiratory distress syndrome and encouraged to use low-tidal-volume ventilation in clinical practice. Alternative modes of ventilation such as high-frequency ventilation and prone position should be reserved for selected patients in whom conventional lung-protective ventilation strategies have failed.

*Mayo Clinic College of Medicine, Division of Pulmonary and Critical Care Medicine, Rochester, MN, USA

Akdeniz University, Medical Faculty, Department of Anaesthesiology and Intensive Care, Antalya, Turkey

Correspondence to: Murat Yilmaz, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA. E-mail:; Tel: +1 507 255 6051; Fax: +1 507 255 4267

Accepted for publication 12 October 2007

First published online 16 November 2007

© 2008 European Society of Anaesthesiology