Citation

Marongiu I, Slobod D, Leali M, Spinelli E, Mauri T. J. Clin. Med. 2024; 13(14).

Copyright

(Copyright © 2024, MDPI: Multidisciplinary Digital Publishing Institute)

DOI

10.3390/jcm13144018

PMID

39064059

PMCID

PMC11278124

Abstract

Patient self-inflicted lung injury (P-SILI) is a major challenge for the ICU physician: although spontaneous breathing is associated with physiological benefits, in patients with acute respiratory distress syndrome (ARDS), the risk of uncontrolled inspiratory effort leading to additional injury needs to be assessed to avoid delayed intubation and increased mortality. In the present review, we analyze the available clinical and experimental evidence supporting the existence of lung injury caused by uncontrolled high inspiratory effort, we discuss the pathophysiological mechanisms by which increased effort causes P-SILI, and, finally, we consider the measurements and interpretation of bedside physiological measures of increased drive that should alert the clinician. The data presented in this review could help to recognize injurious respiratory patterns that may trigger P-SILI and to prevent it.

Language: en

Keywords

monitoring; esophageal pressure; lung injury; respiratory drive