2020 Dec 15. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2020 Jan–.
ABSTRACT
Ventilator-induced lung injury (VILI) is the acute lung injury inflicted or aggravated by mechanical ventilation during treatment. Ventilator-induced lung injury could occur during invasive as well as non-invasive ventilation and might contribute significantly to the morbidity and mortality of critically ill patients. Though mechanical ventilation potentially injures both normal and diseased lungs, the injury will be much more severe in the latter due to higher microscale stresses. Ventilator-induced lung injury (VILI) has been used synonymously with ventilator-associated lung injury (VALI). However, the latter terminology is more appropriate when the lung injury is strongly presumed to be due to ventilation but lacking any strong evidence to confirm the same.
The concept of injury by mechanical ventilation dates back to 1744 when John Fothergill, after successful resuscitation of a patient by mouth to mouth respiration, expressed the view that mouth to mouth ventilation might be a better option than machine bellows in resuscitation since the latter could potentially harm the lungs with the uncontrolled push of air. Investigators during the 1952 polio epidemic had documented structural lung damages caused by mechanical ventilation.
In 1967, the term “respirator lung” was coined to describe the post mortem lung pathology of patients who had undergone mechanical ventilation and whose lungs showed extensive alveolar infiltrates and hyaline membrane formation. Further confirmatory evidence for ventilator-induced lung injury comes from the landmark ARDS Nett trial, where low tidal volume ventilation was proved to be superior to high tidal volume ventilation in ARDS patients.