Clinical and Experimental Evidence for Patient Self-Inflicted Lung Injury (P-SILI) and Bedside Monitoring

被引:3
|
作者
Marongiu, Ines [1 ]
Slobod, Douglas [2 ]
Leali, Marco [3 ]
Spinelli, Elena [1 ]
Mauri, Tommaso [1 ,3 ]
机构
[1] Fdn IRCCS Ca Granda Osped Maggiore Policlin, Dept Anesthesia Crit Care & Emergency, I-20122 Milan, Italy
[2] McGill Univ, Dept Crit Care Med, Montreal, PQ H4A 3J1, Canada
[3] Univ Milan, Dept Pathophysiol & Transplantat, Milan, Italy
关键词
lung injury; esophageal pressure; respiratory drive; monitoring; EXTRACORPOREAL MEMBRANE-OXYGENATION; HIGH TRANSPULMONARY PRESSURE; SPONTANEOUS BREATHING EFFORT; HIGH RESPIRATORY EFFORT; MECHANICAL VENTILATION; ESOPHAGEAL CATHETER; NONINVASIVE METHOD; PENDELLUFT; IMPEDANCE; DRIVE;
D O I
10.3390/jcm13144018
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
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.
引用
收藏
页数:15
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