Lung protective strategy to prevent ventilator induced lung injury

What is the lung protective strategy to prevent ventilator induced lung injury? 

The goal of the lung protective strategy is to improve alveoli recruitment while limiting derecruitment and overdistention.

Currently, there is wide consensus that Vt restriction to 6 mL/kg ideal body weight and/or plateau airway pressures (PPlat) limited below 30 cm H O may prevent lung injury.

Vt could be decreased to a minimal value of 4 mL/kg of predicted body weight in both groups in case of PPlat higher than 32 cm H O, or it could be increased to a maximal value of 8 mL/kg of predicted body weight in case of severe acidosis defined as arterial pH lower than 7.15.

Patients with intracranial processes pose a unique challenge since carbon dioxide elevations can lead to increased intracranial pressure (ICP).

Therefore, these patients need to be monitored closely and their ICP measured.

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