Key messages

• Increasing lung volume and not increasing airway pressure accounts for the hemodynamic effects of mechanical ventilation.

• Hyperinflation increases pulmonary vascular resistance by compressing the alveolar vessels.

• Lung collapse, as occurs during acute lung injury, increases pulmonary vascular resistance by inducing hypoxic pulmonary vasoconstriction.

• Ventilatory strategies that restore end-expiratory lung volumes to basal levels will be associated with the lowest levels of pulmonary vascular resistance.

• Increasing intrathoracic pressure decreases venous return by increasing right atrial pressure.

• Increases in intrathoracic pressure decrease left ventricular afterload, whereas decreases in intrathoracic pressure increase left ventricular afterload.

• All forms of mechanical ventilation share similar hemodynamic outcomes based on their effects on lung volume, intrathoracic pressure, and work of breathing. For the same mean airway pressure and work of breathing, all forms of mechanical ventilation should have similar hemodynamic effects.

• Weaning from mechanical ventilatory support is exercise.

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