What is the main concern when using high tidal volumes in mechanical ventilation?

The primary concern when utilizing high tidal volumes in mechanical ventilation is the risk of barotrauma or volutrauma to the lungs. High tidal volumes can lead to excessive pressure within the alveoli, causing the alveolar walls to stretch beyond their capacity. This type of mechanical injury can result in the rupture of alveoli, which subsequently allows air to escape into the pleural space or surrounding lung tissue, causing complications such as pneumothorax or pulmonary edema.

In addition to causing physical damage to lung tissues, barotrauma can significantly affect gas exchange and overall respiratory function, potentially leading to acute respiratory distress syndrome (ARDS) or other serious lung injuries. It is essential for clinicians to carefully monitor and adjust tidal volumes during mechanical ventilation to prevent such adverse effects, thus ensuring the safety and stability of the patient's respiratory status.

Other options like hypotension, pneumothorax, and metabolic alkalosis are potential complications that might arise in various clinical situations but are not directly attributed to the use of high tidal volumes in mechanical ventilation to the same extent as barotrauma or volutrauma.