Ventilator-induced lung injury (VILI) results from mechanical disruption of blood-gas barrier and consequent edema and releases of inflammatory mediators. A transpulmonary pressure (PL) of 17 cmH2O increases baby lung volume to its anatomical limit, predisposing to VILI. Viscoelastic property of lung makes pulmonary mechanics time dependent so that stress (PL) increases with respiratory rate. Alveolar inhomogeneity in acute respiratory distress syndrome acts as a stress riser, multiplying global stress at regional level experienced by baby lung. Limitation of stress (PL) rather than strain (tidal volume [VT]) is the safe strategy of mechanical ventilation to prevent VILI. Driving pressure is the noninvasive surrogate of lung strain, but its relations to PL is dependent on the chest wall compliance. Determinants of lung stress (VT, driving pressure, positive end-expiratory pressure, and inspiratory flow) can be quantified in terms of mechanical power, and a safe threshold can be determined, which can be used in decision-making between safe mechanical ventilation and extracorporeal lung support.
Fothergill J. Observation on a case published in the last volume of the medical essays, and c. of recovering a man dead in appearance, by distending the lungs with air. Philos Trans R Soc Lond 1745;43:275-81.
Macklin MT, Macklin CC. Malignant interstitial emphysema of lungs and mediastinum as an important occult complication in many respiratory diseases and other conditions: An interpretation of the clinical literature in the light of laboratory experiment. Medicine 1944;23:281-358.
Mead J, Takishima T, Leith D. Stress distribution in lungs: A model of pulmonary elasticity. J Appl Physiol 1970;28:596-608.
Bouhuys A. Physiology and musical instruments. Nature 1969;221:1199-204.
Dreyfuss D, Soler P, Basset G, Saumon G. High inflation pressure pulmonary edema. Respective effects of high airway pressure, high tidal volume, and positive end-expiratory pressure. Am Rev Respir Dis 1988;137:1159-64.
Webb HH, Tierney DF. Experimental pulmonary edema due to intermittent positive pressure ventilation with high inflation pressures. Protection by positive end-expiratory pressure. Am Rev Respir Dis 1974;110:556-65.
Tierney DF. Ventilator-induced lung injury occurs in rats, but does it occur in humans? Am J Respir Crit Care Med 2003;168:1414-5.
Tremblay LN, Slutsky AS. Ventilator-induced injury: From barotrauma to biotrauma. Proc Assoc Am Physicians 1998;110:482-8.
West JB. Thoughts on the pulmonary blood-gas barrier. Am J Physiol Lung Cell Mol Physiol 2003;285:L501-13.
Gattinoni L, Carlesso E, Caironi P. Stress and strain within the lung. Curr Opin Crit Care 2012;18:42-7.
Blankman P, Hasan D, Bikker IG, Gommers D. Lung stress and strain calculation in mechanically ventilated patients in Intensive Care Unit. Acta Anaesthesiol Scand 2016;60:69-78.
Chiumello D, Carlesso E, Cadringher P, Caironi P, Valenza F, Polli F, et al. Lung stress and strain during mechanical ventilation for acute respiratory distress syndrome. Am J Respir Crit Care Med 2008;178:346-55.
Gibson C, Roberts F. Anaesthesia data. In: Allman K, editor. Oxford Handbook of Anesthesia. 4th ed. Oxford: Oxford University Press; 2016.
Protti A, Votta E, Gattinoni L. Which is the most important strain in the pathogenesis of ventilator-induced lung injury: Dynamic or static? Curr Opin Crit Care 2014;20:33-8.
Nihat O, editor. Mechanical properties of biological tissues. In: Fundamentals of Biomechanics: Equilibrium, Motion and Deformation. 3rd ed. New York: Springer; 2012. p. 221-36.
Protti A, Andreis DT, Monti M, Santini A, Sparacino CC, Langer T, et al. Lung stress and strain during mechanical ventilation: Any difference between statics and dynamics? Crit Care Med 2013;41:1046-55.