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The role of spontaneous effort during mechanical ventilation: normal lung versus injured lung.

Yoshida T, Uchiyama A, Fujino Y - J Intensive Care (2015)

Bottom Line: Thus, increased transpulmonary pressure provides various benefits for gas exchange, ventilation pattern, and lung aeration.Thus, during the early stages of severe ARDS, the strict control of transpulmonary pressure and prevention of Pendelluft should be achieved with the short-term use of muscle paralysis.When there is preserved spontaneous effort in ARDS, spontaneous effort should be maintained at a modest level, as the transpulmonary pressure and the effect size of Pendelluft depend on the intensity of the spontaneous effort.

View Article: PubMed Central - PubMed

Affiliation: Intensive Care Unit, Osaka University Hospital, 2-15 Yamadaoka, Suita, Osaka 565-0871 Japan.

ABSTRACT
The role of preserving spontaneous effort during mechanical ventilation and its interaction with mechanical ventilation have been actively investigated for several decades. Inspiratory muscle activities can lower the pleural components surrounding the lung, leading to an increase in transpulmonary pressure when spontaneous breathing effort is preserved during mechanical ventilation. Thus, increased transpulmonary pressure provides various benefits for gas exchange, ventilation pattern, and lung aeration. However, it is important to note that these beneficial effects of preserved spontaneous effort have been demonstrated only when spontaneous effort is modest and lung injury is less severe. Recent studies have revealed the 'dark side' of spontaneous effort during mechanical ventilation, especially in severe lung injury. The 'dark side' refers to uncontrollable transpulmonary pressure due to combined high inspiratory pressure with excessive spontaneous effort and the injurious lung inflation pattern of Pendelluft (i.e., the translocation of air from nondependent lung regions to dependent lung regions). Thus, during the early stages of severe ARDS, the strict control of transpulmonary pressure and prevention of Pendelluft should be achieved with the short-term use of muscle paralysis. When there is preserved spontaneous effort in ARDS, spontaneous effort should be maintained at a modest level, as the transpulmonary pressure and the effect size of Pendelluft depend on the intensity of the spontaneous effort.

No MeSH data available.


Related in: MedlinePlus

Transpulmonary pressure difference: muscle paralysis vs. spontaneous breathing. Diaphragmatic contraction can elevate transpulmonary pressure with the same airway pressure applied in muscle paralysis, by altering the pleural components surrounding the lung.
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Fig1: Transpulmonary pressure difference: muscle paralysis vs. spontaneous breathing. Diaphragmatic contraction can elevate transpulmonary pressure with the same airway pressure applied in muscle paralysis, by altering the pleural components surrounding the lung.

Mentions: For instance, when we deliver 20 cm H2O of inspiratory airway pressure by the mechanical ventilator, part of Paw is consumed to inflate the chest wall unless spontaneous effort is preserved. As a result, PL to inflate the lung is 15 cm H2O (Figure 1).Figure 1


The role of spontaneous effort during mechanical ventilation: normal lung versus injured lung.

Yoshida T, Uchiyama A, Fujino Y - J Intensive Care (2015)

Transpulmonary pressure difference: muscle paralysis vs. spontaneous breathing. Diaphragmatic contraction can elevate transpulmonary pressure with the same airway pressure applied in muscle paralysis, by altering the pleural components surrounding the lung.
© Copyright Policy - open-access
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4940771&req=5

Fig1: Transpulmonary pressure difference: muscle paralysis vs. spontaneous breathing. Diaphragmatic contraction can elevate transpulmonary pressure with the same airway pressure applied in muscle paralysis, by altering the pleural components surrounding the lung.
Mentions: For instance, when we deliver 20 cm H2O of inspiratory airway pressure by the mechanical ventilator, part of Paw is consumed to inflate the chest wall unless spontaneous effort is preserved. As a result, PL to inflate the lung is 15 cm H2O (Figure 1).Figure 1

Bottom Line: Thus, increased transpulmonary pressure provides various benefits for gas exchange, ventilation pattern, and lung aeration.Thus, during the early stages of severe ARDS, the strict control of transpulmonary pressure and prevention of Pendelluft should be achieved with the short-term use of muscle paralysis.When there is preserved spontaneous effort in ARDS, spontaneous effort should be maintained at a modest level, as the transpulmonary pressure and the effect size of Pendelluft depend on the intensity of the spontaneous effort.

View Article: PubMed Central - PubMed

Affiliation: Intensive Care Unit, Osaka University Hospital, 2-15 Yamadaoka, Suita, Osaka 565-0871 Japan.

ABSTRACT
The role of preserving spontaneous effort during mechanical ventilation and its interaction with mechanical ventilation have been actively investigated for several decades. Inspiratory muscle activities can lower the pleural components surrounding the lung, leading to an increase in transpulmonary pressure when spontaneous breathing effort is preserved during mechanical ventilation. Thus, increased transpulmonary pressure provides various benefits for gas exchange, ventilation pattern, and lung aeration. However, it is important to note that these beneficial effects of preserved spontaneous effort have been demonstrated only when spontaneous effort is modest and lung injury is less severe. Recent studies have revealed the 'dark side' of spontaneous effort during mechanical ventilation, especially in severe lung injury. The 'dark side' refers to uncontrollable transpulmonary pressure due to combined high inspiratory pressure with excessive spontaneous effort and the injurious lung inflation pattern of Pendelluft (i.e., the translocation of air from nondependent lung regions to dependent lung regions). Thus, during the early stages of severe ARDS, the strict control of transpulmonary pressure and prevention of Pendelluft should be achieved with the short-term use of muscle paralysis. When there is preserved spontaneous effort in ARDS, spontaneous effort should be maintained at a modest level, as the transpulmonary pressure and the effect size of Pendelluft depend on the intensity of the spontaneous effort.

No MeSH data available.


Related in: MedlinePlus