Protecting lungs during spontaneous breathing: what can we do?

Shortly after stepping into the new millennium, VILI raised extensive attention among clinicians when implementing mechanical ventilation for supporting or treating patients with acute respiratory failure. A wide awareness of the clinical importance of VILI resulted from a large randomized control trial in acute respiratory distress syndrome (ARDS) conducted by the ARDS Network (1). This landmark trial tamped down the causal link between VILI and outcomes that had been suggested by a series of classic experimental studies since 1970s (2) and an indispensable clinical study on lung protective ventilation in 1998 (3).