Dissipation of energy during the respiratory cycle: conditional importance of ergotrauma to structural lung damage.

Abstract:

PURPOSE OF REVIEW:To describe and put into context recent conceptual advances regarding the relationship of energy load and power to ventilator-induced lung injury (VILI). RECENT FINDINGS:Investigative emphasis regarding VILI has almost exclusively centered on the static characteristics of the individual tidal cycle - tidal volume, plateau pressure, positive end-expiratory pressure, and driving pressure. Although those static characteristics of the tidal cycle are undeniably important, the 'dynamic' characteristics of ventilation must not be ignored. To inflict the nonrupturing damage we identify as VILI, work must be performed and energy expended by high stress cycles applied at rates that exceed the capacity of endogenous repair. Machine power, the pace at which the work performing energy load is applied by the ventilator, has received increasing scrutiny as a candidate for the proximate and integrative cause of VILI. SUMMARY:Although the unmodified values of machine-delivered energy or power (which are based on airway pressures and tidal volumes) cannot serve unconditionally as a rigid and quantitative guide to ventilator adjustment for lung protection, bedside consideration of the dynamics of ventilation and potential for ergotrauma represents a clear conceptual advance that complements the static parameters of the individual tidal cycle that with few exceptions have held our scientific attention.

journal_name

Curr Opin Crit Care

authors

Marini JJ

doi

10.1097/MCC.0000000000000470

subject

Has Abstract

pub_date

2018-02-01 00:00:00

pages

16-22

issue

1

eissn

1070-5295

issn

1531-7072

journal_volume

24

pub_type

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