Newly Published
Clinical Focus Review  |   January 2019
Lung- and Diaphragm-protective Ventilation in Acute Respiratory Distress Syndrome: Rationale and Challenges
Author Notes
  • From the Department of Critical Care Medicine, Antwerp University Hospital, University of Antwerp, Edegem, Belgium (T.S.); the Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Canada (E.C.G.); the Department of Medicine, Division of Respirology, University Health Network, Toronto, Canada (E.C.G.); and the Toronto General Hospital Research Institute, Toronto, Canada (E.C.G.).
  • Submitted for publication May 3, 2018. Accepted for publication November 30, 2018.
    Submitted for publication May 3, 2018. Accepted for publication November 30, 2018.×
  • Correspondence: Address correspondence to Dr. Goligher: Toronto General Hospital, 585 University Avenue, Peter Munk Building, 11th Floor, Room 192, Toronto, Ontario, Canada M5G 2N2. ewan.goligher@utoronto.ca. Information on purchasing reprints may be found at www.anesthesiology.org or on the masthead page at the beginning of this issue. Anesthesiology’s articles are made freely accessible to all readers, for personal use only, 6 months from the cover date of the issue.
Article Information
Respiratory System / Clinical Focus Review
Clinical Focus Review   |   January 2019
Lung- and Diaphragm-protective Ventilation in Acute Respiratory Distress Syndrome: Rationale and Challenges
Anesthesiology Newly Published on January 22, 2019. doi:10.1097/ALN.0000000000002605
Anesthesiology Newly Published on January 22, 2019. doi:10.1097/ALN.0000000000002605
Mechanical ventilation can injure both the lung and the diaphragm, leading to substantial morbidity and mortality in ventilated patients. Whereas the importance of lung-protective ventilation is well established, the concept of diaphragm-protective ventilation is an important but unproven new paradigm in the field. A novel approach to mechanical ventilation in the intensive care unit integrating both diaphragm- and lung-protective measures has the potential to accelerate liberation from mechanical ventilation, prevent long-term disability, and increase survival after acute respiratory failure. In this review, we describe the evidence supporting this new paradigm and outline the basic approach to a lung- and diaphragm-protective ventilation strategy.