What is volutrauma in mechanical ventilation?

Updated: Apr 11, 2019
  • Author: Christopher D Jackson, MD; Chief Editor: Zab Mosenifar, MD, FACP, FCCP  more...
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Answer

Answer

Volutrauma refers to the local overdistention of normal alveoli. Volutrauma has gained recognition over the last 2 decades and is the impetus for the lung protection ventilation with lower tidal volumes of 6–8 mL/kg. Computed tomography scans have demonstrated that ARDS has a heterogeneous pattern of lung involvement. Abnormal consolidated lung is dispersed within normal lung tissue. When a mechanical ventilation breath is forced into the patient, the positive pressure tends to follow the path of least resistance to the normal or relatively normal alveoli, potentially causing overdistention. This overdistention sets off an inflammatory cascade that augments or perpetuates the initial lung injury, causing additional damage to previously unaffected alveoli. The increased local inflammation lowers the patient's potential to recover from ARDS. The inflammatory cascade occurs locally and may augment the systemic inflammatory response as well. Thus, it is possible to develop this atelectrauma without high tidal volumes, indicating the need to have a high index of suspicion for this complication. [1]

Another aspect of volutrauma associated with positive ventilation is the shear force associated with the opening and closing effects on collapsible alveoli. This has also been linked to worsening the local inflammatory cascade. PEEP prevents the alveoli from totally collapsing at the end of exhalation and may be beneficial in preventing this type of injury. Since volutrauma was recognized, lung-protective ventilation strategy is recommended in all patients with ARDS or acute lung injury. [6]  Of note, lung-protective ventilation has not been shown to decrease mortality or other outcomes in non-ARDS mechanically ventilated patients.


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