Question

What are the various types of "ventilator-induced lung injury" (VILI) in patients on prolonged invasive mechanical ventilation?

Hint:

Using lower tidal volumes and appropriate PEEP levels can help minimize the risk of VILI in patients on mechanical ventilation.

Answer 1

Step 1: Understanding Ventilator-Induced Lung Injury (VILI).
Ventilator-induced lung injury (VILI) is a type of lung injury caused by mechanical ventilation, especially when it is prolonged. VILI occurs due to the mechanical forces applied by the ventilator on the lungs, which can exacerbate existing lung damage and cause further harm. The risk of VILI increases with high tidal volumes, high pressures, and prolonged ventilation.

Step 2: Types of VILI.
1. Barotrauma: This is caused by the excessive pressure during mechanical ventilation, leading to the rupture of alveoli and air leakage into the pleural space or other areas. Barotrauma is often seen in patients with stiff or non-compliant lungs.
2. Volutrauma: Volutrauma results from the delivery of excessive tidal volumes. This can stretch the alveolar walls, causing inflammation and edema, which further impairs gas exchange. It is commonly seen in patients receiving high tidal volumes during mechanical ventilation.
3. Atelectrauma: Atelectrauma occurs when areas of the lung collapse during ventilation, often due to low tidal volumes or inadequate positive end-expiratory pressure (PEEP). The collapse and reopening of these lung areas during each breath can lead to injury.
4. Biotrauma: This refers to the inflammation and release of pro-inflammatory mediators caused by mechanical ventilation. The injury triggers a cascade of inflammatory responses, which can worsen lung injury and systemic inflammation.

Step 3: Conclusion.
VILI is a significant concern in patients on prolonged mechanical ventilation. The key types of VILI include barotrauma, volutrauma, atelectrauma, and biotrauma, all of which are caused by various mechanical forces during ventilation.