Lung- and Diaphragm-protective Ventilation in Acute Respiratory Distress Syndrome

Rationale and Challenges

Tom Schepens, M.D., Ph.D.; Ewan C. Goligher, M.D., Ph.D.


Anesthesiology. 2019;130(4):620-633. 

In This Article

Abstract and Introduction


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.