A commonly held belief about avoiding ventilator-induced lung injury primarily takes into account the inflation half-cycle, whereas deflation is considered to be a passive process about which very little can be done to influence the lung function of patients (1). Is this belief actually correct? We know that patients should be ventilated without harming the lung (so-called rotective lung ventilation) (2). This may be achieved by combining low VT with the correct amount of positive end-expiratory pressure (PEEP) to minimize the mechanical load on the ventilated lung. However, mechanical ventilation is different from the physiological mechanism that mammals use for gas exchange, in which the inspiratory flow is obtained by the negative pressure generated by the inspiratory muscle. Expiration is often believed to be passive and determined by the elastic recoil pressure of the lung, as it is during physiological ventilation. Unfortunately, expiration is not an exclusively passive phenomenon. The diaphragm not only acts as an inspiratory muscle but also exerts a braking action aimed at slowing down the expiratory flow (3).

A Physiological Point of View on Expiratory (Re)action during Mechanical Ventilation

Spadaro S
Primo
;
Volta CA.
Ultimo
2020

Abstract

A commonly held belief about avoiding ventilator-induced lung injury primarily takes into account the inflation half-cycle, whereas deflation is considered to be a passive process about which very little can be done to influence the lung function of patients (1). Is this belief actually correct? We know that patients should be ventilated without harming the lung (so-called rotective lung ventilation) (2). This may be achieved by combining low VT with the correct amount of positive end-expiratory pressure (PEEP) to minimize the mechanical load on the ventilated lung. However, mechanical ventilation is different from the physiological mechanism that mammals use for gas exchange, in which the inspiratory flow is obtained by the negative pressure generated by the inspiratory muscle. Expiration is often believed to be passive and determined by the elastic recoil pressure of the lung, as it is during physiological ventilation. Unfortunately, expiration is not an exclusively passive phenomenon. The diaphragm not only acts as an inspiratory muscle but also exerts a braking action aimed at slowing down the expiratory flow (3).
2020
Spadaro, S; Volta, Ca.
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Utilizza questo identificativo per citare o creare un link a questo documento: https://hdl.handle.net/11392/2471341
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