Ventilation in the trauma and surgical patient

Changes in the understanding of the pathophysiology of ARDS and effects of mechanical ventilation with high pressures have led to treatment strategies that resulted in improved survival rates. The central principle in these strategies is to avoid ventilation induced lung injury by allowing the lungs to rest. A number of promising new treatments emphasizing this principle are under investigation. Physicians caring for patients who develop ARDS should make every effort to avoid alveolar overdistention by ventilating patients in the compliant portion of pressure-flow loop and avoid peak inspiratory pressures in excess of 40 cm H2O.