Which practice best minimizes ventilator-induced lung injury (VILI)?

• A. Deep sedation only
• B. Low tidal volumes with appropriate PEEP
• C. Rotate patient frequently without ventilator setting changes
• D. High tidal volumes with no PEEP

Answer: (B)

Minimizing ventilator-induced lung injury relies on lung-protective ventilation that reduces the forces and repeated opening of the airways. Using small tidal volumes limits overdistension of lung units (volutrauma/barotrauma), while adding appropriate PEEP keeps alveoli open at the end of expiration, preventing collapse and the injury from repetitive opening and closing (atelectrauma). Together, these settings also help keep driving and plateau pressures lower, which correlates with less lung injury. Deep sedation alone doesn’t address the mechanical forces causing VILI, and simply rotating the patient without changing ventilator settings won’t prevent injury from the ventilation itself. High tidal volumes with no PEEP markedly increase overdistension and atelectasis, worsening injury. So, the lung-protective approach with low tidal volumes and appropriate PEEP best minimizes VILI.