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Patient self-inflicted lung injury: implications for acute hypoxemic respiratory failure and ARDS patients on non-invasive support.
Minerva Anestesiol. 2019 Sep; 85(9):1014-1023.MA

Abstract

The role of spontaneous breathing among patients with acute hypoxemic respiratory failure and ARDS is debated: while avoidance of intubation with noninvasive ventilation (NIV) or high-flow nasal cannula improves clinical outcome, treatment failure worsens mortality. Recent data suggest patient self-inflicted lung injury (P-SILI) as a possible mechanism aggravating lung damage in these patients. P-SILI is generated by intense inspiratory effort yielding: (A) swings in transpulmonary pressure (i.e. lung stress) causing the inflation of big volumes in an aerated compartment markedly reduced by the disease-induced aeration loss; (B) abnormal increases in transvascular pressure, favouring negative-pressure pulmonary edema; (C) an intra-tidal shift of gas between different lung zones, generated by different transmission of muscular force (i.e. pendelluft); (D) diaphragm injury. Experimental data suggest that not all subjects are exposed to the development of P-SILI: patients with a PaO2/FiO2 ratio below 200 mmHg may represent the most at risk population. For them, current evidence indicates that high-flow nasal cannula alone may be superior to intermittent sessions of low-PEEP NIV delivered through face mask, while continuous high-PEEP helmet NIV likely promotes treatment success and may mitigate lung injury. The optimal initial noninvasive treatment of hypoxemic respiratory failure/ARDS remains however uncertain; high-flow nasal cannula and high-PEEP helmet NIV are promising tools to enhance success of the approach, but the best balance between these techniques has yet to be identified. During noninvasive support, careful clinical monitoring remains mandatory for prompt detection of treatment failure, in order not to delay intubation and protective ventilation.

Authors+Show Affiliations

Institute of Anesthesiology and Resuscitation, Sacred Heart Catholic University, Rome, Italy - dlgrieco@outlook.it. Department of Emergency, Anesthesiology and Resuscitation Sciences, A. Gemelli University Polyclinic, IRCCS and Foundation, Rome, Italy - dlgrieco@outlook.it.Institute of Anesthesiology and Resuscitation, Sacred Heart Catholic University, Rome, Italy. Department of Emergency, Anesthesiology and Resuscitation Sciences, A. Gemelli University Polyclinic, IRCCS and Foundation, Rome, Italy.Institute of Anesthesiology and Resuscitation, Sacred Heart Catholic University, Rome, Italy. Department of Emergency, Anesthesiology and Resuscitation Sciences, A. Gemelli University Polyclinic, IRCCS and Foundation, Rome, Italy.Institute of Anesthesiology and Resuscitation, Sacred Heart Catholic University, Rome, Italy. Department of Emergency, Anesthesiology and Resuscitation Sciences, A. Gemelli University Polyclinic, IRCCS and Foundation, Rome, Italy.

Pub Type(s)

Journal Article
Review

Language

eng

PubMed ID

30871304

Citation

Grieco, Domenico L., et al. "Patient Self-inflicted Lung Injury: Implications for Acute Hypoxemic Respiratory Failure and ARDS Patients On Non-invasive Support." Minerva Anestesiologica, vol. 85, no. 9, 2019, pp. 1014-1023.
Grieco DL, Menga LS, Eleuteri D, et al. Patient self-inflicted lung injury: implications for acute hypoxemic respiratory failure and ARDS patients on non-invasive support. Minerva Anestesiol. 2019;85(9):1014-1023.
Grieco, D. L., Menga, L. S., Eleuteri, D., & Antonelli, M. (2019). Patient self-inflicted lung injury: implications for acute hypoxemic respiratory failure and ARDS patients on non-invasive support. Minerva Anestesiologica, 85(9), 1014-1023. https://doi.org/10.23736/S0375-9393.19.13418-9
Grieco DL, et al. Patient Self-inflicted Lung Injury: Implications for Acute Hypoxemic Respiratory Failure and ARDS Patients On Non-invasive Support. Minerva Anestesiol. 2019;85(9):1014-1023. PubMed PMID: 30871304.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Patient self-inflicted lung injury: implications for acute hypoxemic respiratory failure and ARDS patients on non-invasive support. AU - Grieco,Domenico L, AU - Menga,Luca S, AU - Eleuteri,Davide, AU - Antonelli,Massimo, Y1 - 2019/03/12/ PY - 2019/3/16/pubmed PY - 2020/7/28/medline PY - 2019/3/16/entrez SP - 1014 EP - 1023 JF - Minerva anestesiologica JO - Minerva Anestesiol VL - 85 IS - 9 N2 - The role of spontaneous breathing among patients with acute hypoxemic respiratory failure and ARDS is debated: while avoidance of intubation with noninvasive ventilation (NIV) or high-flow nasal cannula improves clinical outcome, treatment failure worsens mortality. Recent data suggest patient self-inflicted lung injury (P-SILI) as a possible mechanism aggravating lung damage in these patients. P-SILI is generated by intense inspiratory effort yielding: (A) swings in transpulmonary pressure (i.e. lung stress) causing the inflation of big volumes in an aerated compartment markedly reduced by the disease-induced aeration loss; (B) abnormal increases in transvascular pressure, favouring negative-pressure pulmonary edema; (C) an intra-tidal shift of gas between different lung zones, generated by different transmission of muscular force (i.e. pendelluft); (D) diaphragm injury. Experimental data suggest that not all subjects are exposed to the development of P-SILI: patients with a PaO2/FiO2 ratio below 200 mmHg may represent the most at risk population. For them, current evidence indicates that high-flow nasal cannula alone may be superior to intermittent sessions of low-PEEP NIV delivered through face mask, while continuous high-PEEP helmet NIV likely promotes treatment success and may mitigate lung injury. The optimal initial noninvasive treatment of hypoxemic respiratory failure/ARDS remains however uncertain; high-flow nasal cannula and high-PEEP helmet NIV are promising tools to enhance success of the approach, but the best balance between these techniques has yet to be identified. During noninvasive support, careful clinical monitoring remains mandatory for prompt detection of treatment failure, in order not to delay intubation and protective ventilation. SN - 1827-1596 UR - https://www.unboundmedicine.com/medline/citation/30871304/Patient_self_inflicted_lung_injury:_implications_for_acute_hypoxemic_respiratory_failure_and_ARDS_patients_on_non_invasive_support_ L2 - https://www.minervamedica.it/index2.t?show=R02Y2019N09A1014 DB - PRIME DP - Unbound Medicine ER -