Commentaries on Viewpoint: Looking beyond macroventilatory parameters and rethinking ventilator-induced lung injury

Abstract

Current methods of mechanical ventilator management consist of mostly macroparameters that are only reflecting the values of the lungs as a whole and not considerate of heterogeneity of the microenvironment (2). suggested the microenvironment of the lungs will undergo mechanical stress due to an unevenly distributed tidal volume during ventilation, resulting in lung injury, additional inflammation, and possible rupturing of alveolar cell membranes.We agree that the aforementioned side effects are a serious call for more research needing to be done in the field of mechanical ventilation techniques. The statement that there is no optimal positive end expiratory pressure (PEEP) for mechanical ventilation, as one of the potential macroparameters responsible for possible injuries, needs to be further explored (2). Setting the PEEP above the lower inflection point may have merit in preventing injuries in addition to keeping superimposed airway pressure below applied airway pressure to prevent potential collapses of lung units (1, 3). Sundersan et al. ( 4) created a new model-based recruitment tool that would help in determining an "optimal" PEEP by evaluating threshold opening pressure (TOP) and threshold closing pressure (TCP) distributed for each part of breathing cycles at a given PEEP. A standard deviation and mean value for TOP and TCP can be derived from the given information and the distributions uniquely depicted the patient's condition and state of their diseases (4, 5). This is a potential noteworthy way to individualize each patients' PEEP, and future studies should look more into recruitment models.