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Semin Respir Crit Care Med 2022; 43(03): 346-368
DOI: 10.1055/s-0042-1748917
Review Article

Monitoring Lung Injury Severity and Ventilation Intensity during Mechanical Ventilation

Emanuele Rezoagli
1   School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
2   Department of Emergency and Intensive Care, San Gerardo University Hospital, Monza, Italy
,
John G. Laffey   *
3   School of Medicine, National University of Ireland, Galway, Ireland
4   Department of Anaesthesia and Intensive Care Medicine, Galway University Hospitals, Saolta University Hospital Group, Galway, Ireland
5   Lung Biology Group, Regenerative Medicine Institute (REMEDI) at CÚRAM Centre for Research in Medical Devices, National University of Ireland Galway, Galway, Ireland
,
Giacomo Bellani   *
1   School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
2   Department of Emergency and Intensive Care, San Gerardo University Hospital, Monza, Italy
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Abstract

Acute respiratory distress syndrome (ARDS) is a severe form of respiratory failure burden by high hospital mortality. No specific pharmacologic treatment is currently available and its ventilatory management is a key strategy to allow reparative and regenerative lung tissue processes. Unfortunately, a poor management of mechanical ventilation can induce ventilation induced lung injury (VILI) caused by physical and biological forces which are at play. Different parameters have been described over the years to assess lung injury severity and facilitate optimization of mechanical ventilation. Indices of lung injury severity include variables related to gas exchange abnormalities, ventilatory setting and respiratory mechanics, ventilation intensity, and the presence of lung hyperinflation versus derecruitment. Recently, specific indexes have been proposed to quantify the stress and the strain released over time using more comprehensive algorithms of calculation such as the mechanical power, and the interaction between driving pressure (DP) and respiratory rate (RR) in the novel DP multiplied by four plus RR [(4 × DP) + RR] index. These new parameters introduce the concept of ventilation intensity as contributing factor of VILI. Ventilation intensity should be taken into account to optimize protective mechanical ventilation strategies, with the aim to reduce intensity to the lowest level required to maintain gas exchange to reduce the potential for VILI. This is further gaining relevance in the current era of phenotyping and enrichment strategies in ARDS.

Keywords

lung injury - mechanical ventilation - gas exchange - respiratory mechanics - ventilation intensity

* John G. Laffey and Giacomo Bellani are co–senior authors.




Publication History

Article published online:
27 July 2022

© 2022. Thieme. All rights reserved.

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