Patient-Self Inflicted Lung Injury: A Practical Review
Guillaume Carteaux,Guillaume Carteaux,Mélodie Parfait,Margot Combet,Anne-Fleur Haudebourg,Samuel Tuffet,Samuel Tuffet,Armand Mekontso Dessap +7 more
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TLDR
In this article, the main pathophysiological mechanisms by which the patient's respiratory effort could become deleterious: excessive transpulmonary pressure resulting in over-distension; inhomogeneous distribution of transpulo-minimization 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.Abstract:
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.read more
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Opportunities for improved clinical trial designs in acute respiratory distress syndrome.
Katherine D. Wick,Neil R. Aggarwal,Martha A. Q. Curley,Alpha A. Fowler,Samir Jaber,Maciej Kostrubiec,Nathalie Lassau,Pierre-François Laterre,Guillaume Lebreton,Joseph E. Levitt,Alexandre Mebazaa,Eileen Rubin,Pratik Sinha,Lorraine B. Ware,Michael A. Matthay +14 more
TL;DR: In this article , the authors recommend two primary strategies to improve future acute respiratory distress syndrome (ARDS) trials: the development of new methods to target treatable traits in clinical trial populations, and improvements in the representativeness of ARDS trials, with the inclusion of global populations.
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Venovenous Extracorporeal Membrane Oxygenation in Awake Non-Intubated Patients With COVID-19 ARDS at High Risk for Barotrauma
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TL;DR: V-ECMO in awake and spontaneously breathing patients with severe COVID-19 ARDS may be a feasible and safe strategy to prevent the development of PNX/PMD in patients at high risk for this complication.
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Spontaneous pneumomediastinum: a surrogate of P-SILI in critically ill COVID-19 patients
Alexandre Elabbadi,Tomas Urbina,Enora Berti,Damien Contou,Gaëtan Plantefève,Quintana Soulier,Audrey Milon,Guillaume Carteaux,Guillaume Voiriot,Muriel Fartoukh,Aude Gibelin +10 more
TL;DR: In this article , the authors describe the prevalence and outcomes of spontaneous pneumomediastinum (SP) during severe COVID-19 with pneumonia before any IMV, to rule out mechanisms induced by IMV in the development of pneumonia.
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Lung and diaphragm protective ventilation: a synthesis of recent data
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Pendelluft as a predictor of weaning in critically ill patients: An observational cohort study
TL;DR: In this article , the accuracy of pendelluft during the spontaneous breathing trials (SBT) was evaluated as a predictor of weaning outcome of patients with mechanical ventilation, which may be related to diaphragm function.
References
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High Inflation Pressure Pulmonary Edema: Respective Effects of High Airway Pressure, High Tidal Volume, and Positive End-expiratory Pressure
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