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VOLUME 21 , ISSUE 8 ( 2017 ) > List of Articles

REVIEW ARTICLE

Mathematics of ventilator-induced lung injury

Ubaidur Rahaman

Keywords : Baby lung, driving pressure, strain, stress, transpulmonary pressure, ventilator-induced lung injury

Citation Information : Rahaman U. Mathematics of ventilator-induced lung injury. Indian J Crit Care Med 2017; 21 (8):521-524.

DOI: 10.4103/ijccm.IJCCM_411_16

License: CC BY-ND 3.0

Published Online: 00-08-2017

Copyright Statement:  Copyright © 2017; Jaypee Brothers Medical Publishers (P) Ltd.


Abstract

Ventilator-induced lung injury (VILI) results from mechanical disruption of blood-gas barrier and consequent edema and releases of inflammatory mediators. A transpulmonary pressure (PL) of 17 cmH2O increases baby lung volume to its anatomical limit, predisposing to VILI. Viscoelastic property of lung makes pulmonary mechanics time dependent so that stress (PL) increases with respiratory rate. Alveolar inhomogeneity in acute respiratory distress syndrome acts as a stress riser, multiplying global stress at regional level experienced by baby lung. Limitation of stress (PL) rather than strain (tidal volume [VT]) is the safe strategy of mechanical ventilation to prevent VILI. Driving pressure is the noninvasive surrogate of lung strain, but its relations to PL is dependent on the chest wall compliance. Determinants of lung stress (VT, driving pressure, positive end-expiratory pressure, and inspiratory flow) can be quantified in terms of mechanical power, and a safe threshold can be determined, which can be used in decision-making between safe mechanical ventilation and extracorporeal lung support.


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