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Limiting plateau pressures to less than 30 cm water is an effective approach for all patients.With volume ventilators, this is best accomplished with low tidal volumes.

With increasing evidence to support its use, the overall tidal volume used in mechanically ventilated patients had decreased over time, and current practice involves tidal volumes that are lower than those used in the past.An appreciation of the pathophysiology of barotrauma in mechanically ventilated patients improves the understanding of its clinical manifestations.It is important to recognize that lung involvement in persons with ARDS is heterogeneous and that some portions of the lungs are more adversely affected than others.This involvement can lead to maldistribution of mechanically delivered tidal volume, with some alveoli subjected to more distention than others.Pressures between adjacent alveoli may initially equilibrate, but alveolar pressures eventually increase, creating a pressure gradient between the alveoli and adjacent perivascular sheath.

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