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Measures to assess potential lung injury during ventilation inadequate
Date:8/15/2008

Ventilator-induced injury to the lungs can contribute to prolonged respiratory failure and even death among patients with acute respiratory distress syndrome (ARDS). Even post-operative patients with previously healthy lungs, who require temporary mechanical ventilation, are at risk of ventilator-induced lung injury. Such injuries have been reduced tremendously during the last 20 years since studies had demonstrated ventilators should be set to deliver lower breath volumes (tidal volumes) so as to reduce the stress and strain on fragile alveoli damaged by ARDS. According to a new study, however, we may have much further to go to reduce ventilator-induced lung injury.

"It is ironic, because for a large number of patients with ARDS it is the treatment, rather the syndrome, which ends up killing them" says Luciano Gattinoni, M.D., lead researcher on the study.

The study was published in the second issue for August of the American Journal of Respiratory and Critical Care Medicine, by the American Thoracic Society.

In the early 1970's, the mortality rate for ARDS was up to 90 percent. Now, that rate has fallen to about 40 percent. Dr. Gattinoni attributes the bulk of that improvement to improved understanding and refinement of mechanical ventilation protocol. Currently, to assess lung strain, clinicians estimate tidal volume based on patients' weight. "Now we apply tidal volumes normalized per ideal body weight of six to eight mL/kg, down from 12 to 15," he says. Currently, to assess lung strain in order to ensure that even a lower set tidal volume does not cause excessive stress, clinicians can only measure end-inspiratory plateau pressure generated by the delivered tidal volume.

Assessing patients' lung stress and strain accurately could mean the difference between life and death. Overestimating stress and delivering too low of a tidal volume may lead to carbon dioxide build-up in the blood and atelectasis-lu
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Contact: Keely Savoie
ksavoie@thoracic.org
212-315-8620
American Thoracic Society
Source:Eurekalert

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