Pulmonary barotrauma during mechanical ventilation

Kumar, Anil; Pontoppidan, Henning; Falke, K. J.; Wilson, Roger S.; Laver, Myron B.

doi:10.1097/00003246-197307000-00001

Cited by 187 publications

(71 citation statements)

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“…Excessive pressure leading to macroscopic rupture of lung parenchyma is the first recognized cause of ventilator lung injury and was referred to as barotrauma (2). This includes pneumothorax, pneumomediastinum, subcutaneous emphysema (6-9) and gas embolism (10).…”

Section: Pressurementioning

confidence: 99%

Driving pressure and mechanical power: new targets for VILI prevention

et al. 2017

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Several factors have been recognized as possible triggers of ventilator-induced lung injury (VILI).The first is pressure (thus the 'barotrauma'), then the volume (hence the 'volutrauma'), finally the cyclic opening-closing of the lung units ('atelectrauma'). Less attention has been paid to the respiratory rate and the flow, although both theoretical considerations and experimental evidence attribute them a significant role in the generation of VILI. The initial injury to the lung parenchyma is necessarily mechanical and it could manifest as an unphysiological distortion of the extracellular matrix and/or as micro-fractures in the hyaluronan, likely the most fragile polymer embedded in the matrix. The order of magnitude of the energy required to break a molecular bond between the hyaluronan and the associated protein is 1.12×10 -16 Joules (J), 70-90% higher than the average energy delivered by a single breath of 1L assuming a lung elastance of 10 cmH 2 O/L (0.5 J). With a normal statistical distribution of the bond strength some polymers will be exposed each cycle to an energy large enough to rupture. Both the extracellular matrix distortion and the polymer fractures lead to inflammatory increase of capillary permeability with edema if a pulmonary blood flow is sufficient. The mediation analysis of higher vs. lower tidal volume and PEEP studies suggests that the driving pressure, more than tidal volume, is the best predictor of VILI, as inferred by increased mortality. This is not surprising, as both tidal volume and respiratory system elastance (resulting in driving pressure) may independently contribute to the mortality. For the same elastance driving pressure is a predictor similar to plateau pressure or tidal volume. Driving pressure is one of the components of the mechanical power, which also includes respiratory rate, flow and PEEP. Finding the threshold for mechanical power would greatly simplify assessment and prevention of VILI.

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Section: Pressurementioning

confidence: 99%

Driving pressure and mechanical power: new targets for VILI prevention

et al. 2017

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“…However, life-threatening complications such as pneumothorax occurred and mortality was high [65]. With the introduction of positive end-expiratory pressure (PEEP), oxygen uptake improved and the incidence of pneumothoraces in ARDS patients was reduced dramatically [66][67][68].…”

Section: Mechanical Ventilationmentioning

confidence: 99%

Pediatric acute lung injury

Dahlem

Aalderen

Bos

2007

Paediatric Respiratory Reviews

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“…Pneumonia is an important predisposing factor in the development of pulmonary barotrauma in mechanically ventilated patients [28] . Necrotizing bacterial pneumonia can cause air leaks into the pleura that result in development of pneumothorax [29] .…”

Section: Disease Associated With Pneumothoraxmentioning

confidence: 99%

“…There have also been correlations made between high peak airway pressure and the development of pneumothorax [15,36] . High PEEP had been reported to be associated with pneumothorax [1] but several studies have found no such relationship [15,17,23,28,37] . Increased pressure is not enough by itself to produce alveolar rupture, with some studies demonstrating that pneumothorax is related to high tidal volume [37] .…”

Section: Factors For Prmvmentioning

confidence: 99%

Iatrogenic pneumothorax related to mechanical ventilation

Hsu¹

2014

WJCCM

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ral space prevents sonographic visualization of visceral pleura movements. Mechanically ventilated patients with a pneumothorax require tube thoracostomy placement because of the high risk of tension pneumothorax. Small-bore catheters are now preferred in the majority of ventilated patients. Furthermore, if there are clinical signs of a tension pneumothorax, emergency needle decompression followed by tube thoracostomy is widely advocated. Patients with pneumothorax related to mechanical ventilation who have tension pneumothorax, a higher acute physiology and chronic health evaluation Ⅱ score or PaO2/FiO2 < 200 mmHg were found to have higher mortality.© 2014 Baishideng Publishing Group Co., Limited. All rights reserved. Key words: Barotrauma; Complication; Critical care; Mechanical ventilation; PneumothoraxCore tip: Patients with pneumothorax related to mechanical ventilation (PRMV) have a high mortality rate. PRMV often occurs in the early stage of mechanical ventilation and it may recur on the other side of lung in a short period of time. Low compliance is associated with a high incidence of PRMV, with PRMV being more related to the underlying process than the ventilatory setting. PRMV patients with tension pneumothorax, higher acute physiology and chronic health evaluation score or PaO2/FiO2 < 200 mmHg have a higher mortality.Hsu CW, Sun SF. Iatrogenic pneumothorax related to mechanical ventilation.

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Pulmonary barotrauma during mechanical ventilation

Cited by 187 publications

References 0 publications

Driving pressure and mechanical power: new targets for VILI prevention

Driving pressure and mechanical power: new targets for VILI prevention

Pediatric acute lung injury

Iatrogenic pneumothorax related to mechanical ventilation

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