Practical assessment of risk of VILI from ventilating power: a conceptual model

Critical Care

卷:27

Perspective

Luciano Gattinoni¹  Philip S. Crooke²  John J. Marini³  Lauren T. Thornton³  Patricia R. M. Rocco⁴ 

[1] Department of Anesthesiology, University of Göttingen, Göttingen, Germany;

[2] Department of Mathematics, Vanderbilt University, Nashville, TN, USA;

[3] Department of Pulmonary and Critical Care Medicine, University of Minnesota, Minneapolis/St Paul, MN, USA;

[4] Laboratory of Pulmonary Investigation, Carlos Chagas Filho Biophysics Institute, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil;

关键词: Ventilator-induced lung injury;    Energy;    Power;    Mathematical model;    Lung protection;   

DOI  :  10.1186/s13054-023-04406-9

 received in 2023-01-24, accepted in 2023-03-16,  发布年份 2023

来源: Springer

【 摘 要 】

At the bedside, assessing the risk of ventilator-induced lung injury (VILI) requires parameters readily measured by the clinician. For this purpose, driving pressure (DP) and end-inspiratory static ‘plateau’ pressure (Ps\documentclass[12pt]{minimal}\usepackage{amsmath}\usepackage{wasysym}\usepackage{amsfonts}\usepackage{amssymb}\usepackage{amsbsy}\usepackage{mathrsfs}\usepackage{upgreek}\setlength{\oddsidemargin}{-69pt}\begin{document}$$P_{s}$$\end{document}) of the tidal cycle are unquestionably useful but lack key information relating to associated volume changes and cumulative strain. ‘Mechanical power’, a clinical term which incorporates all dissipated (‘non-elastic’) and conserved (‘elastic’) energy components of inflation, has drawn considerable interest as a comprehensive ‘umbrella’ variable that accounts for the influence of ventilating frequency per minute as well as the energy cost per tidal cycle. Yet, like the raw values of DP and Ps\documentclass[12pt]{minimal}\usepackage{amsmath}\usepackage{wasysym}\usepackage{amsfonts}\usepackage{amssymb}\usepackage{amsbsy}\usepackage{mathrsfs}\usepackage{upgreek}\setlength{\oddsidemargin}{-69pt}\begin{document}$$P_{s}$$\end{document}, the absolute levels of energy and power by themselves may not carry sufficiently precise information to guide safe ventilatory practice. In previous work we introduced the concept of ‘damaging energy per cycle’. Here we describe how—if only in concept—the bedside clinician might gauge the theoretical hazard of delivered energy using easily observed static circuit pressures (Ps\documentclass[12pt]{minimal}\usepackage{amsmath}\usepackage{wasysym}\usepackage{amsfonts}\usepackage{amssymb}\usepackage{amsbsy}\usepackage{mathrsfs}\usepackage{upgreek}\setlength{\oddsidemargin}{-69pt}\begin{document}$$P_{s}$$\end{document} and positive end expiratory pressure) and an estimate of the maximally tolerated (threshold) non-dissipated (‘elastic’) airway pressure that reflects the pressure component applied to the alveolar tissues. Because its core inputs are already in use and familiar in daily practice, the simplified mathematical model we propose here for damaging energy and power may promote deeper comprehension of the key factors in play to improve lung protective ventilation.

【 授权许可】

CC BY   
© The Author(s) 2023

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