Lung Protective Strategies of Ventilation in the Neonate: What Are They?

In the July 1999 issue of theJournal of the American Medical Association, Dr Leonard Hudson proclaims that “the concept of ventilator-induced lung injury (VILI) has come of age.”¹  His comments were derived from a report by Ranieri et al²  which shows that a “lung-protective strategy” of respiratory support reduces cytokine levels in both the bronchoalveolar lavage fluid and serum of adult patients with acute respiratory distress syndrome (ARDS). Dr Hudson's enthusiasm is increased by the recent press release from the National Institutes of Health (NIH) ARDS Network Study, reporting positive results of a study evaluating a “lung-protective strategy” in >800 adults with ARDS. The NIH study was stopped early, when the safety monitoring committee noted “25% fewer deaths” among patients receiving small (6 mL/kg) rather than large (12 mL/kg) tidal volumes to support gas exchange.

The importance of these observations is that they provide data in support...