Ventilator-related causes of lung injury: the mechanical power

Gattinoni, Luciano; Tonetti, Tommaso; Cressoni, Massimo; Cadringher, Paolo; Herrmann, Peter; Moerer, Onnen; Protti, Alessandro; Gotti, Miriam; Chiurazzi, Chiara; Carlesso, Eleonora; Chiumello, Davide; Quintel, Michael

doi:10.1007/s00134-016-4505-2

Cited by 632 publications

(658 citation statements)

References 23 publications

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“…(For a given individual, however, tracking risk with total power would still seem prudent during machine adjustments.) The present paper [3] validates an analytical approach to quantifying the raw power load. For humans, dangerous levels (if they exist) must be defined.…”

supporting

confidence: 54%

“…As nicely discussed by the authors, PEEP invariably increases global tissue stresses and strains when tidal volume remains unchanged [3]. Such elevations of baseline pressure amplify tissue tensions and the potentially damaging effects of dynamic tidal excursions.…”

mentioning

confidence: 85%

“…Dynamic characteristics-frequency, flow rate, strain rate-have recently been emphasized as key determinants of whether the 'static' variables inflict injury [2]. In this issue, Gattinoni and colleagues present an elegant and persuasive argument that energy delivered per unit time ('power') is a unifying entity into which most key ventilator settings and forces relevant to VILI can be channeled, thus providing a "composite index" by which to translate this insight into clinical practice [3]. As clearly stated by the authors themselves, the mechanical power concept in the genesis of VILI is not new.…”

mentioning

confidence: 99%

“…However, some power is expended within the lung itself in reversibly The integrating concept of mechanical power represents a significant conceptual step forward in our understanding of how to piece together the experimental and clinical information related to safe and effective lung ventilation. By emphasizing the 'ergotrauma' of delivered power, this important work [3] calls attention to the often neglected mandate to reduce the demand for ventilation as well as the dynamic stress imposed by each individual tidal breath. The innovative concepts elaborated in this impressive work will advance future efforts to refine lung protective strategies for ventilation.…”

mentioning

confidence: 99%

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Dynamic predictors of VILI risk: beyond the driving pressure

Marini

Jaber

2016

Intensive Care Med

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confidence: 54%

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confidence: 85%

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confidence: 99%

mentioning

confidence: 99%

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Dynamic predictors of VILI risk: beyond the driving pressure

Marini

Jaber

2016

Intensive Care Med

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“…(3) Invasive mechanical ventilation: new studies have suggested that high driving pressure (above 13 cmH 2 O) is associated with increased mortality in ARDS [1,12]. Most of the ventilatory parameters might be summarized using the "mechanical power" concept [13]. For the first time, it was shown that patient-ventilator asynchrony was detected in all patients and in all ventilator modes, and was associated with mortality [14].…”

Section: New Parameters For Monitoring Invasive Mechanical Ventilationmentioning

confidence: 99%

Focus on ventilation and airway management in the ICU

2017

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Time to Rethink the Approach to Treating Acute Respiratory Distress Syndrome

Gattinoni

Marini

Quintel

2018

JAMA

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In this issue of JAMA, Fan et al 1 review the treatment of acute respiratory distress syndrome (ARDS), focusing on recent randomized clinical trials (RCTs). Most of these RCTs failed to show that the interventions that were tested offered significant benefit. These predominantly negative results may prompt the question of whether other rational and more-effective ways are available to increase knowledge and improve treatment of a syndrome that is common, deadly, and arguably emblematic of modern intensive care. Although many of these trials were admirably executed, their failure to demonstrate benefit may often have been due to uncertainties regarding enrollment criteria and imprecise deployment of the interventions that were being tested.Critical care physicians and others have learned from laboratory experimentation and clinical observation that the pathobiology of ARDS changes rapidly over hours and days, is highly variable from patient to patient, and is influenced by important co-factors. Thus, wise selection of treatment requires consideration of the timing and intensity of any proposed intervention. Furthermore, patients with ARDS often have multiple concomitant medically and surgically related problems, which can confound interpretation of the effects of ARDS-specific interventions. Perhaps, in rethinking the approach to ARDS, it is valuable to revisit the often-missed link between diagnosis and treatment, with more in-depth understanding of the underlying mechanisms responsible for the clinical manifestations of the syndrome.

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Ventilator-related causes of lung injury: the mechanical power

Abstract: The mechanical power equation may help estimate the contribution of the different ventilator-related causes of lung injury and of their variations. The equation can be easily implemented in every ventilator's software.

Cited by 632 publications

References 23 publications

Dynamic predictors of VILI risk: beyond the driving pressure

Dynamic predictors of VILI risk: beyond the driving pressure

Focus on ventilation and airway management in the ICU

Time to Rethink the Approach to Treating Acute Respiratory Distress Syndrome

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