Unshrinking the baby lung to calm the VILI vortex

Crit Care. 2022 Aug 7;26(1):242. doi: 10.1186/s13054-022-04105-x.

Abstract

A hallmark of ARDS is progressive shrinking of the 'baby lung,' now referred to as the ventilator-induced lung injury (VILI) 'vortex.' Reducing the risk of the VILI vortex is the goal of current ventilation strategies; unfortunately, this goal has not been achieved nor has mortality been reduced. However, the temporal aspects of a mechanical breath have not been considered. A brief expiration prevents alveolar collapse, and an extended inspiration can recruit the atelectatic lung over hours. Time-controlled adaptive ventilation (TCAV) is a novel ventilator approach to achieve these goals, since it considers many of the temporal aspects of dynamic lung mechanics.

Keywords: Acute respiratory distress syndrome (ARDS); Protective mechanical ventilation; Ventilator-induced lung injury (VILI).

Publication types

  • Review

MeSH terms

  • Humans
  • Lung
  • Respiration, Artificial / adverse effects
  • Respiratory Distress Syndrome*
  • Respiratory Physiological Phenomena
  • Ventilator-Induced Lung Injury* / prevention & control