Ventilatory support and mechanical properties of the fibrotic lung acting as a “squishy ball”

Annals of Intensive Care

Lorenzo Ball¹  Paolo Pelosi¹  Manu L. N. G. Malbrain²  Giulio Rossi³  Riccardo Fantini⁴  Stefania Cerri⁴  Luca Tabbì⁴  Alessandro Marchioni⁴  Ivana Castaniere⁴  Maria Rosaria Pellegrino⁴  Enrico Clini⁴  Roberto Tonelli⁴  Elisabetta Cocconcelli⁵  Paolo Spagnolo⁵  Fabrizio Luppi⁶ 

[1] Dipartimento di Scienze Chirurgiche e Diagnostiche Integrate, Università degli Studi di Genova;Intensive Care Unit Department, University Hospital Brussels (UZB);Pathologic Anatomy Unit, Azienda USL Ravenna;Respiratory Diseases Unit, Department of Medical and Surgical Sciences, University Hospital of Modena and Center for Rare Lung Diseases, University of Modena Reggio Emilia;Respiratory Diseases Unit, University of Padua;Respiratory Unit, University of Milano Bicocca, S. Gerardo Hospital;

关键词: Interstitial lung diseases;    Acute respiratory distress syndrome;    Respiratory failure;    Mechanical ventilation;    Ventilator-induced lung injury;   

DOI  :  10.1186/s13613-020-0632-6

来源: DOAJ

【 摘 要 】

Abstract Protective ventilation is the cornerstone of treatment of patients with the acute respiratory distress syndrome (ARDS); however, no studies have yet established the best ventilatory strategy to adopt when patients with acute exacerbation of interstitial lung disease (AE-ILD) are admitted to the intensive care unit. Due to the severe impairment of the respiratory mechanics, the fibrotic lung is at high risk of developing ventilator-induced lung injury, regardless of the lung fibrosis etiology. The purpose of this review is to analyze the effects of mechanical ventilation in AE-ILD and to increase the knowledge on the characteristics of fibrotic lung during artificial ventilation, introducing the concept of “squishy ball lung”. The role of positive end-expiratory pressure is discussed, proposing a “lung resting strategy” as opposed to the “open lung approach”. The review also discusses the practical management of AE-ILD patients discussing illustrative clinical cases.

【 授权许可】

Unknown