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Lung protective ventilation

BMJ 2012; 344 doi: (Published 05 April 2012) Cite this as: BMJ 2012;344:e2491
  1. Luigi Camporota, consultant intensivist1,
  2. Nicholas Hart, consultant in respiratory and critical care medicine2
  1. 1Department of Critical Care, Guy’s and St Thomas’ NHS Foundation Trust, King’s Health Partners, London, UK
  2. 2Lane Fox Respiratory Unit, St Thomas’ Hospital, Guy’s and St Thomas’ NHS Foundation Trust, King’s Health Partners, London SE1 7EH, UK
  1. nicholas.hart{at}

Currently underused—to the detriment of patients

Lung protective ventilation—the provision of mechanical ventilation with static inspiratory pressures (plateau pressure) of less than 30 cm of water and tidal volumes normalised to predicted body weight—is the only treatment that has consistently been shown to reduce mortality in patients with acute lung injury. In a linked study (doi:10.1136/bmj.e2124), Needham and colleagues’ present the data from a multicentre prospective North American observational cohort study and report that patients with acute lung injury are at high risk of both short and long term mortality.1 Acute lung injury is a syndrome that is characterised by diffuse alveolar damage and inflammation, increased pulmonary vascular permeability, and a loss of aerated alveolar tissue, all of which have a catastrophic effect on gas exchange. Although mortality attributable to acute lung injury has fallen over the past 40 years, accumulating evidence suggests that a growing number of patients who survive a stay in intensive care have long term disability and high mortality rates years after discharge.2

Because predicted body weight is calculated from …

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