Mechanical ventilation is a critical intervention in patients who cannot spontaneously maintain adequate oxygenation and remove carbon dioxide. However, it can also lead to severe lung injury via volutrauma, barotrauma, atelectrauma and biotrauma, and it can worsen existing lung disease such as acute respiratory distress syndrome. Ventilator-associated lung injury, the clinical manifestations of lung damage associated with mechanical ventilation, can trigger systemic inflammatory cascades that contribute to multi-organ failure. The utilization of lung-protective ventilation strategies helps to minimize further injury to the lungs during mechanical ventilation and improve survival rates. This review discusses the pathophysiology of ventilator-associated lung injury, including cellular and molecular responses, its systemic effects, risk factors, clinical presentation and diagnosis, protective strategies, and emerging therapies. It incorporates interdisciplinary advances, from novel pharmacologic and stem-cell therapies coupled with artificial intelligence and machine learning systems to provide a framework for the prevention of ventilator-associated lung injury that moves beyond purely mechanical considerations.

Mechanical ventilation is a critical intervention in patients that cannot spontaneously maintain adequate oxygenation and remove carbon dioxide. However, it can also lead to severe lung injury via volutrauma, barotrauma, atelectrauma and biotrauma, and it can worsen existing lung disease such as acute respiratory distress syndrome. Ventilator-associated lung injury, the clinical manifestations of lung damage associated with mechanical ventilation, can trigger systemic inflammatory cascades that contribute to multi-organ failure. The utilization of lung-protective ventilation strategies helps to minimize further injury to the lungs during mechanical ventilation and improve survival rates. This review discusses the pathophysiology of ventilator-associated lung injury, including cellular and molecular responses. its systemic effects, risk factors, clinical presentation and diagnosis, protective strategies, and emerging therapies.