![]() An important characteristic of the lungs of mechanically ventilated patients is heterogeneity that is, some lung units are prone to overdistention and others are prone to collapse. Inflammatory mediators may translocate into the pulmonary circulation, resulting in systemic inflammation. ![]() Ventilating the lungs in a manner that promotes alveolar overdistention and derecruitment increases inflammation in the lungs (biotrauma). This injury is ameliorated by the application of PEEP to avoid alveolar derecruitment. One can define ventilatory mode as the process by which the mechanical ventilator determines, either partially or fully. Ventilator-induced lung injury can also result from cyclical alveolar collapse during exhalation and re-opening during subsequent inhalation. Open or Natural Dehumidification: doors and windows are open and continuous ventilation is provided by air movers. Overdistention is minimized by limiting tidal volume (eg, 4-8 mL/kg ideal body weight) and alveolar distending pressure (< 25 cm H 2O). Thus, a stiff chest wall may be protective against alveolar overdistention. Principles and physiology of mechanical ventilation Initial ventilator settings and adjusments. Alveolar distention is also affected by intrapleural pressure. The peak alveolar pressure (end-inspiratory plateau pressure) should ideally be as low as possible and less than 30 cm H 2O. ![]() Alveolar distention is determined by the difference between intra-alveolar pressure and the intrapleural pressure. ![]() Alveolar overdistention causes acute lung injury. ![]()
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