Ventilatorinduced

Ventilator-induced is a general term for injuries or dysfunctions caused by mechanical ventilation. The most studied manifestations are ventilator-induced lung injury (VILI) and ventilator-induced diaphragmatic dysfunction (VIDD). VILI refers to alveolar damage from mechanical forces, including volutrauma (overdistension from high tidal volumes), barotrauma (injury from high pressures), atelectrauma (repetitive opening and closing of collapsed alveoli), and biotrauma (inflammatory response triggered by mechanical stress). VIDD describes diaphragmatic weakness or atrophy due to diaphragm disuse during controlled ventilation, which can complicate weaning.

Risk factors include high tidal volumes, high plateau pressures, extended duration of ventilation, severe lung disease, and inflammatory states.

Prevention: Use lung-protective ventilation, with tidal volumes around 6 mL/kg predicted body weight; keep plateau pressure below 30 cm H2O; optimize PEEP; consider recruitment maneuvers cautiously; minimize driving pressure; aim for spontaneous breaths when feasible; apply appropriate sedation strategies to facilitate weaning; monitor for diaphragmatic activity; emphasize early mobilization.

Outcomes and management: VILI and VIDD contribute to longer ICU stays and higher mortality; prevention and careful management improve outcomes. In severe cases, adjunctive therapies such as prone positioning or extracorporeal membrane oxygenation (ECMO) may be considered. Note that ventilator-induced is not a standalone diagnostic term in most settings; clinicians typically refer to VILI or VIDD to describe these conditions.