{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,24]],"date-time":"2026-10-24T02:57:54Z","timestamp":1792810674850,"version":"4.5.0"},"reference-count":185,"publisher":"MDPI AG","issue":"11","license":[{"start":{"date-parts":[[2025,6,2]],"date-time":"2025-06-02T00:00:00Z","timestamp":1748822400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Invasive mechanical ventilation is a cornerstone therapy for supporting patients with acute respiratory distress syndrome (ARDS) by relieving respiratory muscle strain and ensuring gas exchange. Despite its life-saving benefits, mechanical ventilation can induce ventilator-induced lung injury (VILI), a critical condition characterized by mechanisms such as barotrauma, volutrauma, atelectrauma, ergotrauma, and biotrauma. This review examines the pathophysiological mechanisms of VILI and their impact on lung function, particularly in patients with ARDS. It highlights the importance of lung-protective ventilation strategies, including low tidal volume and tailored positive end-expiratory pressure, which have been shown to improve outcomes in ARDS. The role of prone positioning in enhancing lung homogeneity and improving outcomes is also discussed. Furthermore, emerging concepts such as mechanical power and individual respiratory mechanics are explored as potential avenues for personalized ventilation strategies. Despite advancements, the optimal approach to mechanical ventilation remains a subject of ongoing research.<\/jats:p>","DOI":"10.3390\/jcm14113910","type":"journal-article","created":{"date-parts":[[2025,6,2]],"date-time":"2025-06-02T10:21:49Z","timestamp":1748859709000},"page":"3910","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":34,"title":["Ventilator-Induced Lung Injury: The Unseen Challenge in Acute Respiratory Distress Syndrome Management"],"prefix":"10.3390","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-0159-1426","authenticated-orcid":false,"given":"Raffaele","family":"Merola","sequence":"first","affiliation":[{"name":"Anesthesia and Intensive Care Medicine, Department of Neurosciences, Reproductive and Odontostomatological Sciences, University of Naples Federico II, 80131 Naples, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7652-970X","authenticated-orcid":false,"given":"Maria","family":"Vargas","sequence":"additional","affiliation":[{"name":"Anesthesia and Intensive Care Medicine, Department of Neurosciences, Reproductive and Odontostomatological Sciences, University of Naples Federico II, 80131 Naples, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6895-6442","authenticated-orcid":false,"given":"Denise","family":"Battaglini","sequence":"additional","affiliation":[{"name":"Department of Surgical Sciences and Integrated Diagnostics (DISC), University of Genoa, 16132 Genova, Italy"},{"name":"Anesthesia and Intensive Care, IRCCS Ospedale Policlinico San Martino, 16132 Genova, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,6,2]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"37","DOI":"10.1016\/S0140-6736(53)92530-6","article-title":"A preliminary report on the 1952 epidemic of poliomyelitis in Copenhagen with special reference to the treatment of acute respiratory insufficiency","volume":"1","author":"Lassen","year":"1953","journal-title":"Lancet"},{"key":"ref_2","first-page":"72","article-title":"The anaesthetist\u2019s viewpoint on the treatment of respiratory complications in poliomyelitis during the epidemic in Copenhagen, 1952","volume":"47","author":"Ibsen","year":"1954","journal-title":"Proc. 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