Mechanical Ventilation to Minimize Progression of Lung Injury in Acute Respiratory Failure

High-flow nasal oxygen therapy and noninvasive ventilation in the management of acute hypoxemic respiratory failure

“…In this situation, spontaneous breathing may be deleterious, aggravating lung injury through changes in global or regional pressure, even without any ventilatory support (18)(19)(20). Brochard et al consequently developed the concept of patient self-inflicted lung injury (P-SILI) (19). Hence, oxygenation strategies are aimed at unloading inspiratory muscles while preserving superimposed lung injuries, in addition to improve oxygenation.…”

Ventilation-induced lung injury exists in spontaneously breathing patients with acute respiratory failure: Yes

“…Spontaneous breathing could increase ventilation by breath stacking [11] or reverse triggering [12], but Yoshida et al also showed that, without increasing tidal volume, spontaneous ventilation with a high respiratory drive could induce an internal redistribution of the inspired tidal volume generating local injurious forces [13]. Recently, we proposed the concept of patient self-inflicted lung injury (P-SILI) to describe all these conditions where a high respiratory drive induced by local lung injury could result in global or regional pressure changes susceptible to aggravating the initial lung injury [14].…”

Extracorporeal techniques in acute respiratory distress syndrome

“…Additionally, it could optimize other intensive care-based management strategies, including minimization of sedation, reductions in nosocomial infections (particularly ventilator-associated pneumonia) and maximization of mobilization and enteral nutrition. However, there is potential concern over exacerbating mechanical stress with spontaneous breathing in ARDS (61)(62)(63)(64)(65). Although ECCO 2 R has been shown to have the ability to control ventilatory drive in select patients with severe, chronic respiratory failure (e.g., COPD), data suggests that it may not be able to sufficiently control the spontaneous and potentially injurious respiratory efforts of patients with severe ARDS (66,67).…”