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Power to mechanical power to minimize ventilator-induced lung injury?

Mechanical ventilation is a life-supportive therapy, but can also promote damage to pulmonary structures, such as epithelial and endothelial cells and the extracellular matrix, in a process referred to as ventilator-induced lung injury (VILI). Recently, the degree of VILI has been related to the amo...

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Autores principales: Silva, Pedro Leme, Ball, Lorenzo, Rocco, Patricia R. M., Pelosi, Paolo
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Springer International Publishing 2019
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6658623/
https://www.ncbi.nlm.nih.gov/pubmed/31346828
http://dx.doi.org/10.1186/s40635-019-0243-4
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author Silva, Pedro Leme
Ball, Lorenzo
Rocco, Patricia R. M.
Pelosi, Paolo
author_facet Silva, Pedro Leme
Ball, Lorenzo
Rocco, Patricia R. M.
Pelosi, Paolo
author_sort Silva, Pedro Leme
collection PubMed
description Mechanical ventilation is a life-supportive therapy, but can also promote damage to pulmonary structures, such as epithelial and endothelial cells and the extracellular matrix, in a process referred to as ventilator-induced lung injury (VILI). Recently, the degree of VILI has been related to the amount of energy transferred from the mechanical ventilator to the respiratory system within a given timeframe, the so-called mechanical power. During controlled mechanical ventilation, mechanical power is composed of parameters set by the clinician at the bedside—such as tidal volume (V(T)), airway pressure (Paw), inspiratory airflow (V′), respiratory rate (RR), and positive end-expiratory pressure (PEEP) level—plus several patient-dependent variables, such as peak, plateau, and driving pressures. Different mathematical equations are available to calculate mechanical power, from pressure-volume (PV) curves to more complex formulas which consider both dynamic (kinetic) and static (potential) components; simpler methods mainly consider the dynamic component. Experimental studies have reported that, even at low levels of mechanical power, increasing V(T) causes lung damage. Mechanical power should be normalized to the amount of ventilated pulmonary surface; the ratio of mechanical power to the alveolar area exposed to energy delivery is called “intensity.” Recognizing that mechanical power may reflect a conjunction of parameters which may predispose to VILI is an important step toward optimizing mechanical ventilation in critically ill patients. However, further studies are needed to clarify how mechanical power should be taken into account when choosing ventilator settings.
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spelling pubmed-66586232019-08-07 Power to mechanical power to minimize ventilator-induced lung injury? Silva, Pedro Leme Ball, Lorenzo Rocco, Patricia R. M. Pelosi, Paolo Intensive Care Med Exp Review Mechanical ventilation is a life-supportive therapy, but can also promote damage to pulmonary structures, such as epithelial and endothelial cells and the extracellular matrix, in a process referred to as ventilator-induced lung injury (VILI). Recently, the degree of VILI has been related to the amount of energy transferred from the mechanical ventilator to the respiratory system within a given timeframe, the so-called mechanical power. During controlled mechanical ventilation, mechanical power is composed of parameters set by the clinician at the bedside—such as tidal volume (V(T)), airway pressure (Paw), inspiratory airflow (V′), respiratory rate (RR), and positive end-expiratory pressure (PEEP) level—plus several patient-dependent variables, such as peak, plateau, and driving pressures. Different mathematical equations are available to calculate mechanical power, from pressure-volume (PV) curves to more complex formulas which consider both dynamic (kinetic) and static (potential) components; simpler methods mainly consider the dynamic component. Experimental studies have reported that, even at low levels of mechanical power, increasing V(T) causes lung damage. Mechanical power should be normalized to the amount of ventilated pulmonary surface; the ratio of mechanical power to the alveolar area exposed to energy delivery is called “intensity.” Recognizing that mechanical power may reflect a conjunction of parameters which may predispose to VILI is an important step toward optimizing mechanical ventilation in critically ill patients. However, further studies are needed to clarify how mechanical power should be taken into account when choosing ventilator settings. Springer International Publishing 2019-07-25 /pmc/articles/PMC6658623/ /pubmed/31346828 http://dx.doi.org/10.1186/s40635-019-0243-4 Text en © The Author(s). 2019 Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made.
spellingShingle Review
Silva, Pedro Leme
Ball, Lorenzo
Rocco, Patricia R. M.
Pelosi, Paolo
Power to mechanical power to minimize ventilator-induced lung injury?
title Power to mechanical power to minimize ventilator-induced lung injury?
title_full Power to mechanical power to minimize ventilator-induced lung injury?
title_fullStr Power to mechanical power to minimize ventilator-induced lung injury?
title_full_unstemmed Power to mechanical power to minimize ventilator-induced lung injury?
title_short Power to mechanical power to minimize ventilator-induced lung injury?
title_sort power to mechanical power to minimize ventilator-induced lung injury?
topic Review
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6658623/
https://www.ncbi.nlm.nih.gov/pubmed/31346828
http://dx.doi.org/10.1186/s40635-019-0243-4
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