Abstract

LOPEZ REYMUNDO, Paulo Sergio et al. Patient self inflicted lung injury. Med. crít. (Col. Mex. Med. Crít.) [online]. 2023, vol.37, n.1, pp.47-51.  Epub Sep 30, 2023. ISSN 2448-8909.  https://doi.org/10.35366/109963.

The optimization of spontaneous effort in mechanical ventilation has a central place in the intensive care unit; provides benefits to patients such as improved gas exchange, helps to regain function of the diaphragm and maintenance of peripheral muscles. On the other hand, it can also be associated with impaired oxygenation and lung injury. The increase in the neural respiratory drive increases the inspiratory muscular effort, conditioning damaging pulmonary distension pressures, which in the context of acute respiratory distress syndrome is of vital importance, since it can cause collapse and regional alveolar overdistention in a cyclical way. with heterogeneous distribution of pulmonary stress and strain. There are three mechanisms of lung injury due to spontaneous effort: overdistention, increased pulmonary perfusion, and patient-ventilator asynchrony. Lung injury causes capillary leakage, pulmonary edema, and impaired gas exchange. This leads to increased respiratory drive and higher tidal volumes of the patient’s own spontaneous breaths, causing capillary leakage and increased lung damage like ventilator-induced lung injury.

Keywords : asynchrony; spontaneous effort; respiratory drive; lung injury; overdistention.