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Ventilator-induced lung injury (VILI) is a potential threat to anyone receiving supportive mechanical ventilation for acute respiratory failure. Despite decades of research, however, the safest way to ventilate any given patient remains controversial. This makes fertile ground for novel concepts, and one that has arisen recently concerns the idea that a ventilator imparts potentially damaging mechanical energy to the lungs. The motivation for this concept is clear: energy transfer is involved when any structure becomes physically damaged. It may be intuitive, then, that the rate at which energy is delivered to the lungs by a ventilator, namely mechanical power, should be associated with VILI. Nevertheless, understanding the relationship between mechanical power and VILI requires clarity on the difference between stored versus dissipated energy regardless of whether ventilation is caused by positive pressure at the airway opening or negative pressure in the pleural space.
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Unshrinking the baby lung to calm the VILI vortex
Abstract A hallmark of ARDS is progressive shrinking of the ‘baby lung,’ now referred to as the ventilator-induced lung injury (VILI) ‘vortex.’ Reducing the risk of the VILI vortex is the goal of current ventilation strategies; unfortunately, this goal has not been achieved nor has mortality been reduced. However, the temporal aspects of a mechanical breath have not been considered. A brief expiration prevents alveolar collapse, and an extended inspiration can recruit the atelectatic lung over hours. Time-controlled adaptive ventilation (TCAV) is a novel ventilator approach to achieve these goals, since it considers many of the temporal aspects of dynamic lung mechanics.
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- Award ID(s):
- 1706801
- PAR ID:
- 10472639
- Publisher / Repository:
- Springer Nature
- Date Published:
- Journal Name:
- Critical Care
- Volume:
- 26
- Issue:
- 1
- ISSN:
- 1364-8535
- Subject(s) / Keyword(s):
- Acute respiratory distress syndrome (ARDS), Ventilator-induced lung injury (VILI), Protective mechanical ventilation
- Format(s):
- Medium: X
- Sponsoring Org:
- National Science Foundation
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- Free Publicly Accessible Full Text
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Accepted Manuscript1.0
- Journal Article:
- https://doi.org/10.1186/s13054-022-04105-x
