ICU Physiology in 1000 Words: Patient Self-Inflicted Lung Injury – Part 1
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Jon-Emile S. Kenny MD [@heart_lung] Background In an excellent review from early 2016, Gattinoni and Quintel note that ventilator induced lung injury [VILI] is better considered ventilation induced lung injury because VILI can develop during spontaneous breathing [1]. To support this claim, they reference a classic experimental study from the late 1980s by Mascheroni and colleagues [2]. In this oft-cited work from over 30 years ago, 16 sheep had sodium salicylate injected into their cisterna magnae to trigger central hyperventilation. These sheep developed clinical respiratory distress syndrome typified by both diminished arterial oxygenation and respiratory system compliance, coupled with abnormal chest x-rays and grossly injured lungs. Another 10 sheep had salicylate injected into their cisterna magnae, however, they were sedated, paralyzed and placed on mechanical ventilation with normal tidal volume. None of the latter sheep developed lung injury over the same time frame. Appropriately, the authors concluded that, in their experimental paradigm, hyperventilation
ICU Physiology in 1000 Words: Patient Self-Inflicted Lung Injury – Part 1
ICU Physiology in 1000 Words: Patient…
ICU Physiology in 1000 Words: Patient Self-Inflicted Lung Injury – Part 1
Jon-Emile S. Kenny MD [@heart_lung] Background In an excellent review from early 2016, Gattinoni and Quintel note that ventilator induced lung injury [VILI] is better considered ventilation induced lung injury because VILI can develop during spontaneous breathing [1]. To support this claim, they reference a classic experimental study from the late 1980s by Mascheroni and colleagues [2]. In this oft-cited work from over 30 years ago, 16 sheep had sodium salicylate injected into their cisterna magnae to trigger central hyperventilation. These sheep developed clinical respiratory distress syndrome typified by both diminished arterial oxygenation and respiratory system compliance, coupled with abnormal chest x-rays and grossly injured lungs. Another 10 sheep had salicylate injected into their cisterna magnae, however, they were sedated, paralyzed and placed on mechanical ventilation with normal tidal volume. None of the latter sheep developed lung injury over the same time frame. Appropriately, the authors concluded that, in their experimental paradigm, hyperventilation