[Patient Self-inflicted Lung Injury (P-SILI): pathophysiology and clinical implications].

Area of Science:

• Pulmonology
• Critical Care Medicine
• Physiology

Background:

• Patient self-inflicted lung injury (P-SILI) is a concept where excessive respiratory drive exacerbates acute hypoxemic respiratory failure (AHRF).
• Mechanisms include increased lung stress, heterogeneous ventilation, augmented pulmonary blood flow, and patient-ventilator asynchrony (PVA) during non-invasive ventilation (NIV).
• Elevated respiratory drive often stems from underlying lung pathology like alveolar flooding.

Purpose of the Study:

• To highlight the importance of preventing P-SILI in acute respiratory failure management.
• To discuss the limitations of current monitoring techniques for respiratory effort.
• To emphasize the need for individualized ventilatory support strategies.

Main Methods:

• Review of existing literature on P-SILI mechanisms and management.
• Discussion of monitoring techniques like esophageal pressure measurement.
• Analysis of therapeutic interventions such as NIV, high-flow nasal cannula, pharmacological agents, and prone positioning.

Main Results:

• Current monitoring methods for respiratory drive are often invasive and resource-intensive.
• Late failure of NIV with delayed intubation is linked to increased mortality.
• Therapeutic interventions for P-SILI have limitations requiring continuous evaluation.

Conclusions:

• Preventing P-SILI is essential in managing ARDS and AHRF.
• Individualized and continuously reassessed ventilatory support is critical.
• More robust clinical trial evidence is needed for P-SILI prevention, treatment, and optimal intubation timing.