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A Model of Self-limited Acute Lung Injury by Unilateral Intra-bronchial Acid Instillation
Published on: August 30, 2019
Acute lung injury in thoracic surgery
Giorgio Della Rocca1, Cecilia Coccia
1Department of Anesthesia and Intensive Care Medicine, University of Udine, Udine, Italy. giorgio.dellarocca@uniud.it
Current Opinion in Anaesthesiology
|December 14, 2012
Summary
Thoracic surgery patients face acute lung injury (ALI) risks from ventilation. Protective strategies, including low tidal volumes and PEEP, can reduce injury, but require careful application.
Area of Science:
- Anesthesiology
- Critical Care Medicine
- Thoracic Surgery
Background:
- Acute lung injury (ALI) is a significant cause of mortality following thoracic surgery.
- Multiple factors contribute to ALI pathogenesis, including preoperative conditions, surgical inflammation, ventilator use, fluid management, and transfusions.
Purpose of the Study:
- To review risk factors for ALI in thoracic surgery patients.
- To discuss lung injury occurrence during mechanical ventilation and one-lung ventilation (OLV).
- To explore strategies for preventing lung injury during thoracic procedures.
Main Methods:
- Review of existing literature on ALI in thoracic surgery.
- Analysis of evidence regarding ventilator-induced lung injury (VILI) during OLV.
- Discussion of protective ventilation strategies.
Main Results:
- Conventional OLV often uses high tidal volumes, high FiO2, and no PEEP, potentially increasing ALI risk.
- Recent studies suggest low tidal volumes reduce inflammatory mediators and postoperative pulmonary complications.
- Protective ventilation strategies, while beneficial, require careful implementation to avoid harm.
Conclusions:
- Ventilation goals include minimizing lung trauma (overdistension, alveolar collapse) while ensuring adequate oxygenation.
- Protective ventilation encompasses low tidal volumes, PEEP, lower FiO2, recruitment maneuvers, and reduced ventilatory pressures.
- Optimizing ventilation strategies is crucial for reducing ALI in thoracic surgery patients.
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