Patient self-inflicted lung injury - does it really exist?

Area of Science:

• Critical Care Medicine
• Pulmonology
• Mechanical Ventilation

Background:

• Patient self-inflicted lung injury (P-SILI) is a proposed mechanism of lung damage.
• The concept suggests that patient-generated tidal volumes can cause alveolar injury.

Purpose of the Study:

• To critically evaluate the experimental evidence supporting the existence of P-SILI.
• To review the claims made regarding P-SILI's role in COVID-19 lung injury and its impact on ventilator management strategies.

Main Methods:

• Systematic review of existing literature on P-SILI.
• Analysis of arguments and evidence presented by proponents of P-SILI.
• Examination of ventilator management recommendations during the COVID-19 pandemic in light of P-SILI claims.

Main Results:

• The review found a lack of robust experimental data to substantiate the existence of P-SILI.
• During the COVID-19 pandemic, P-SILI was controversially implicated in lung injury, leading to significant changes in ventilator management.
• Proponents of P-SILI provided unconvincing evidence when challenged.

Conclusions:

• Claims for P-SILI are based on weak circumstantial evidence.
• The burden of proof lies with those making the claim of P-SILI.
• Decades of established ventilator management principles were potentially overridden based on an unproven hypothesis.