Citation

Pettenuzzo T, Sella N, Zarantonello F, De Cassai A, Geraldini F, Persona P, Pistollato E, Boscolo A, Navalesi P. Expert Rev. Respir. Med. 2022; ePub(ePub): ePub.

Copyright

(Copyright © 2022, Future Drugs)

DOI

10.1080/17476348.2022.2128335

PMID

36154791

Abstract

INTRODUCTION: Patient self-inflicted lung injury (P-SILI) has been proposed as a form of lung injury caused by strong inspiratory efforts consequent to a high respiratory drive in patients with hypoxemic acute respiratory failure (hARF). Increased respiratory drive and effort may lead to variable combinations of deleterious phenomena, such as excessive transpulmonary pressure, pendelluft, intra-tidal recruitment, local lung volutrauma, and pulmonary edema. Gas exchange and respiratory mechanics derangements further increase respiratory drive and effort, thus inducing a vicious circle. Forms of partial ventilatory support may further add to the detrimental effects of P-SILI. Since P-SILI may worsen patient outcome, strategies aimed at identifying and preventing P-SILI would be of great importance. AREAS COVERED: We systematically searched Pubmed since inception until April 15, 2022 to review the patho-physiological mechanisms of P-SILI and the strategies to identify those patients at risk of P-SILI. EXPERT OPINION: Although the concept of P-SILI has been increasingly supported by experimental and clinical data, no study has insofar demonstrated the efficacy of any strategy to identify it in the clinical setting. Further experimental and clinical research is thus needed to ascertain the detrimental effects of spontaneous breathing and identify patients with hARF at high risk of developing P-SILI.

Language: en

Keywords

mechanical ventilation; inspiratory effort; patient self-inflicted lung injury; pendelluft; pulmonary edema; respiratory drive; spontaneous breathing