Key messages

• The iatrogenic factors contributing to failure of mechanical ventilation are as follows:

1. high peak airway pressure and tidal volumes;

2. inappropriate level of positive end-expiratory pressure;

3. shear stress;

4. toxicity of high inspired oxygen concentrations;

5. nosocomial infection.

• Disease factors contributing to worsening of gas exchange are as follows:

1. insufficient viable lung tissue for the demands of the patient;

2. an initiating cause of the acute respiratory distress syndrome remains inadequately treated.

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