Related Experiment Video
Updated: Jun 5, 2026
08:22
3D Cine Magnetic Resonance Imaging of Respiratory Motion in Mechanically Ventilated Mice and Rats
Published on: September 19, 2025
Ventilator-induced lung injury: the anatomical and physiological framework
Luciano Gattinoni1, Alessandro Protti, Pietro Caironi
1Dipartimento di Anestesiologia, Università degli Studi di Milano, Milan, Italy. gattinon@policlinico.mi.it
Critical Care Medicine
|December 18, 2010
Summary
Mechanical ventilation for acute respiratory distress syndrome is not always dangerous. Ventilator-induced lung injury occurs only above a specific stress/strain threshold, suggesting safe use below this limit.
Area of Science:
- Pulmonary Medicine
- Critical Care Medicine
- Respiratory Physiology
Background:
- Mechanical ventilation is essential for acute respiratory distress syndrome (ARDS) management.
- Historically, mechanical ventilation has been associated with lung injury, evolving from barotrauma to volutrauma, atelectrauma, and biotrauma.
- Understanding the mechanisms of ventilator-induced lung injury (VILI) is crucial for optimizing patient outcomes.
Purpose of the Study:
- To describe the anatomical and physiological basis of VILI.
- To analyze the concept of lung stress and strain in VILI.
- To challenge conventional beliefs regarding VILI and propose a threshold-based safety limit for mechanical ventilation.
Main Methods:
- Review of anatomical and physiological principles of VILI.
- Analysis of lung stress/strain concepts in whole lung and regional contexts.
- Evaluation of existing data on tidal volumes and positive end-expiratory pressures in VILI.
Main Results:
- VILI is linked to pressure heterogeneity between open and closed lung units, exacerbated by high tidal volumes.
- The concept of lung stress/strain is central to understanding VILI.
- Rupture stress is rarely reached; VILI is likely a threshold phenomenon.
Conclusions:
- Mechanical ventilation may be safe below a certain stress/strain threshold.
- High tidal volumes contribute to VILI by increasing pressure heterogeneity.
- A paradigm shift towards a threshold-based understanding of VILI is suggested.
Related Concept Videos
01:23Mechanical Ventilation II: Invasive Ventilation
Ventilators are essential medical equipment used to aid patients with respiratory difficulties. Their primary function is to assist or replace spontaneous breathing by providing mechanical ventilation. There are two general classes of mechanical ventilators: negative-pressure and positive-pressure ventilators.
Negative-Pressure Ventilators
Negative-pressure ventilators create a vacuum around the chest or body to draw air into the lungs, simulating breathing. This method does not require an...
Negative-Pressure Ventilators
Negative-pressure ventilators create a vacuum around the chest or body to draw air into the lungs, simulating breathing. This method does not require an...
01:29Mechanical Ventilation I: Indication and Settings
Mechanical ventilation is a life-saving technique for managing acute respiratory failure and other respiratory complications. The process involves using a machine known as a ventilator to supply oxygen to the lungs and assist in removing carbon dioxide. It serves as a bridge to long-term mechanical ventilation or a temporary measure until ventilatory support is discontinued. The ventilator can maintain this function for a prolonged period, providing critical support for patients until they can...
01:10Atelectasis II: Pathophysiology
Atelectasis develops when alveoli lose their air and collapse inward. Because lung tissue is naturally elastic, these air sacs shrink rather than remaining open. Collapsed alveoli are no longer ventilated, reducing their role in gas exchange. Blood flow may continue in these regions, creating a ventilation–perfusion mismatch. Clinical findings include decreased breath sounds, dullness to percussion, reduced chest expansion, and decreased tactile fremitus as sound transmission through collapsed...
01:08Pneumothorax II: Pathophysiology
Pneumothorax means the presence of air in the pleural space — the thin potential gap between the visceral and parietal pleura. This condition disrupts the normal pressure balance that keeps the lungs inflated, leading to partial or complete collapse of the affected lung.Normal physiologyUnder normal conditions, the pleural space maintains a slightly negative intrapleural pressure, which keeps the lungs expanded against the chest wall. This negative pressure creates a delicate balance between...
01:14Ventilatory Modes
Mechanical ventilators are life-saving devices that support or replace spontaneous breathing. They deliver breaths to patients through varying methods known as ventilator modes. Understanding these modes is critical for healthcare providers managing patients with respiratory failure.
There are three ventilatory modes: full support, partial support, and spontaneous. These are described below.
Full Support Modes
Full support modes include controlled mechanical ventilation, continuous mandatory...
There are three ventilatory modes: full support, partial support, and spontaneous. These are described below.
Full Support Modes
Full support modes include controlled mechanical ventilation, continuous mandatory...
01:24Pulmonary Ventilation: Inhalation
Pulmonary ventilation is a vital process that ensures the exchange of oxygen and carbon dioxide in the lungs. It refers to the movement of air into and out of the lungs, enabling the body to obtain oxygen and remove waste carbon dioxide. In this article, we will explore the intricacies of pulmonary ventilation, including its underlying principles, mechanisms, and the interplay of pressures within the respiratory system.
Boyle's law becomes particularly pertinent when examining respiratory...
Boyle's law becomes particularly pertinent when examining respiratory...