Mechanical Ventilation Bringing the ICU Into the Operating Room

Abstract

Patients who become critically ill from sepsis, acute respiratory illness or other inflammatory processes often require intubation and mechanical ventilation to support respiratory function. The lungs are very susceptible to injury in these circumstances and may develop the syndromes of acute lung injury (ALI) and acute respiratory distress syndrome (ARDS). Furthermore, patients in the operating room under anesthesia may also develop lung injury due to direct surgical trauma (pneumonectomy), aspiration, transfusion, shock, or allergic reaction. The approaches and techniques of mechanical ventilation continue to evolve with better understanding of the pathophysiology of ALI/ARDS. In this article, we will (a) review the definitions of ALI/ARDS, (b) define lung-protective ventilation and the etiologies of ventilator-associated lung injury, (c) discuss rescue therapies for hypoxemic respiratory failure, and (d) describe newer modes of mechanical ventilation in use both in the ICU and the operating room.