Patient-Self Inflicted Lung Injury: A Practical Review
Patients with severe lung injury usually have a high respiratory drive, resulting in intense inspiratory effort that may even worsen lung damage by several mechanisms gathered under the name “patient-self inflicted lung injury” (P-SILI). Even though no clinical study has yet demonstrated that a vent...
| Main Authors: | , , , , , |
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| Format: | Article |
| Language: | English |
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MDPI AG
2021-06-01
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| Series: | Journal of Clinical Medicine |
| Subjects: | |
| Online Access: | https://www.mdpi.com/2077-0383/10/12/2738 |
| _version_ | 1797529376397459456 |
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| author | Guillaume Carteaux Mélodie Parfait Margot Combet Anne-Fleur Haudebourg Samuel Tuffet Armand Mekontso Dessap |
| author_facet | Guillaume Carteaux Mélodie Parfait Margot Combet Anne-Fleur Haudebourg Samuel Tuffet Armand Mekontso Dessap |
| author_sort | Guillaume Carteaux |
| collection | DOAJ |
| description | Patients with severe lung injury usually have a high respiratory drive, resulting in intense inspiratory effort that may even worsen lung damage by several mechanisms gathered under the name “patient-self inflicted lung injury” (P-SILI). Even though no clinical study has yet demonstrated that a ventilatory strategy to limit the risk of P-SILI can improve the outcome, the concept of P-SILI relies on sound physiological reasoning, an accumulation of clinical observations and some consistent experimental data. In this review, we detail the main pathophysiological mechanisms by which the patient’s respiratory effort could become deleterious: excessive transpulmonary pressure resulting in over-distension; inhomogeneous distribution of transpulmonary pressure variations across the lung leading to cyclic opening/closing of nondependent regions and pendelluft phenomenon; increase in the transvascular pressure favoring the aggravation of pulmonary edema. We also describe potentially harmful patient-ventilator interactions. Finally, we discuss in a practical way how to detect in the clinical setting situations at risk for P-SILI and to what extent this recognition can help personalize the treatment strategy. |
| first_indexed | 2024-03-10T10:12:57Z |
| format | Article |
| id | doaj.art-bacade9c13f84320b033328edcb9a980 |
| institution | Directory Open Access Journal |
| issn | 2077-0383 |
| language | English |
| last_indexed | 2024-03-10T10:12:57Z |
| publishDate | 2021-06-01 |
| publisher | MDPI AG |
| record_format | Article |
| series | Journal of Clinical Medicine |
| spelling | doaj.art-bacade9c13f84320b033328edcb9a9802023-11-22T01:05:01ZengMDPI AGJournal of Clinical Medicine2077-03832021-06-011012273810.3390/jcm10122738Patient-Self Inflicted Lung Injury: A Practical ReviewGuillaume Carteaux0Mélodie Parfait1Margot Combet2Anne-Fleur Haudebourg3Samuel Tuffet4Armand Mekontso Dessap5Assistance Publique-Hôpitaux de Paris, CHU Henri Mondor, Service de Médecine Intensive Réanimation, F-94010 Créteil, FranceAssistance Publique-Hôpitaux de Paris, CHU Henri Mondor, Service de Médecine Intensive Réanimation, F-94010 Créteil, FranceAssistance Publique-Hôpitaux de Paris, CHU Henri Mondor, Service de Médecine Intensive Réanimation, F-94010 Créteil, FranceAssistance Publique-Hôpitaux de Paris, CHU Henri Mondor, Service de Médecine Intensive Réanimation, F-94010 Créteil, FranceAssistance Publique-Hôpitaux de Paris, CHU Henri Mondor, Service de Médecine Intensive Réanimation, F-94010 Créteil, FranceAssistance Publique-Hôpitaux de Paris, CHU Henri Mondor, Service de Médecine Intensive Réanimation, F-94010 Créteil, FrancePatients with severe lung injury usually have a high respiratory drive, resulting in intense inspiratory effort that may even worsen lung damage by several mechanisms gathered under the name “patient-self inflicted lung injury” (P-SILI). Even though no clinical study has yet demonstrated that a ventilatory strategy to limit the risk of P-SILI can improve the outcome, the concept of P-SILI relies on sound physiological reasoning, an accumulation of clinical observations and some consistent experimental data. In this review, we detail the main pathophysiological mechanisms by which the patient’s respiratory effort could become deleterious: excessive transpulmonary pressure resulting in over-distension; inhomogeneous distribution of transpulmonary pressure variations across the lung leading to cyclic opening/closing of nondependent regions and pendelluft phenomenon; increase in the transvascular pressure favoring the aggravation of pulmonary edema. We also describe potentially harmful patient-ventilator interactions. Finally, we discuss in a practical way how to detect in the clinical setting situations at risk for P-SILI and to what extent this recognition can help personalize the treatment strategy.https://www.mdpi.com/2077-0383/10/12/2738patient-self inflicted lung injuryventilator induced lung injuryacute respiratory failureacute respiratory distress syndromeartificial ventilation |
| spellingShingle | Guillaume Carteaux Mélodie Parfait Margot Combet Anne-Fleur Haudebourg Samuel Tuffet Armand Mekontso Dessap Patient-Self Inflicted Lung Injury: A Practical Review Journal of Clinical Medicine patient-self inflicted lung injury ventilator induced lung injury acute respiratory failure acute respiratory distress syndrome artificial ventilation |
| title | Patient-Self Inflicted Lung Injury: A Practical Review |
| title_full | Patient-Self Inflicted Lung Injury: A Practical Review |
| title_fullStr | Patient-Self Inflicted Lung Injury: A Practical Review |
| title_full_unstemmed | Patient-Self Inflicted Lung Injury: A Practical Review |
| title_short | Patient-Self Inflicted Lung Injury: A Practical Review |
| title_sort | patient self inflicted lung injury a practical review |
| topic | patient-self inflicted lung injury ventilator induced lung injury acute respiratory failure acute respiratory distress syndrome artificial ventilation |
| url | https://www.mdpi.com/2077-0383/10/12/2738 |
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