Role of Surfactant in Ventilation-Induced Lung Injury

Ventilation-induced lung injury results from mechanical stress and strain that occur during tidal ventilation in the susceptible lung. Classical descriptions of ventilation-induced lung injury have focused on harm from positive pressure ventilation. However, injurious forces also can be generated by patient effort and patient–ventilator interactions. While the role of global mechanics has long been recognized, regional mechanical heterogeneity within the lungs also appears to be an important factor propagating clinically significant lung injury. The resulting clinical phenotype includes worsening lung injury and a systemic inflammatory response that drives extrapulmonary organ failures. Bedside recognition of ventilation-induced lung injury requires a high degree of clinical acuity given its indistinct presentation and lack of definitive diagnostics. Yet the clinical importance of ventilation-induced lung injury is clear. Preventing such biophysical injury remains the most effective management strategy to decrease morbidity and mortality in patients with acute respiratory distress syndrome and likely benefits others at risk.

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Barotrauma in COVID-19 Patients

Archives of Anesthesia and Critical Care ◽

10.18502/aacc.v8i1.8248 ◽

2022 ◽

Author(s):

Farahnaz Fallahian ◽

Atabak Najafi ◽

Arezoo Ahmadi

Keyword(s):

Retrospective Study ◽

Lung Injury ◽

Host Response ◽

Clinical Manifestations ◽

Chest Imaging ◽

Common Complication ◽

Invasive Ventilation ◽

Pulmonary Barotrauma ◽

Ventilation Induced Lung Injury

Clinical manifestations of COVID 19 is still unknown. We performed this study to determine the occurrence of pulmonary barotrauma as a complication of this disease. In this retrospective study, a total of 955 COVID 19 patients with respiratory insufficiency requiring oxygen support or invasive ventilation admitted to ICU of Sina Hospital from 20 March 2020 to 9 June 2021, were included and their chest imaging reviewed. Here, we report results of chest imaging of first 92 patients of this group. Barotrauma (pneumothorax, pneumomediastinum, pneumopericardium) occurred in 11 (11.9%) of 92 patients with coronavirus disease 2019 (COVID-19) infection requiring ICU admission for respiratory support and monitoring. It seems barotrauma is a common complication of COVID 19 disease. The role of increased respiratory efforts, patient or ventilation induced lung injury, viral and host response should be assessed. It needs to consider the occurrence of barotrauma in Patients with COVID-19, before expansion of dead space for treatment and limiting the ventilation effects.

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Aktuelle Konzepte zur Entstehung und Behandlung eines beatmungsinduzierten Lungenschadens

Karger Kompass Pneumologie ◽

10.1159/000509459 ◽

2020 ◽

Vol 8 (4) ◽

pp. 212-214

Author(s):

Wolfgang Galetke

Keyword(s):

Lung Injury ◽

Positive Pressure Ventilation ◽

Clinical Importance ◽

Positive Pressure ◽

Mechanical Heterogeneity ◽

Organ Failures ◽

Clinically Significant ◽

High Degree ◽

Ventilation Induced Lung Injury

Ventilation-induced lung injury results from mechanical stress and strain that occur during tidal ventilation in the susceptible lung. Classical descriptions of ventilation-induced lung injury have focused on harm from positive pressure ventilation. However, injurious forces also can be generated by patient effort and patient–ventilator interactions. While the role of global mechanics has long been recognized, regional mechanical heterogeneity within the lungs also appears to be an important factor propagating clinically significant lung injury. The resulting clinical phenotype includes worsening lung injury and a systemic inflammatory response that drives extrapulmonary organ failures. Bedside recognition of ventilation-induced lung injury requires a high degree of clinical acuity given its indistinct presentation and lack of definitive diagnostics. Yet the clinical importance of ventilation-induced lung injury is clear. Preventing such biophysical injury remains the most effective management strategy to decrease morbidity and mortality in patients with acute respiratory distress syndrome and likely benefits others at risk.

Download Full-text