Erschienen in:
01.12.2015 | Editorial
Does high-pressure, high-frequency oscillation shake the foundations of lung protection?
verfasst von:
John J. Marini
Erschienen in:
Intensive Care Medicine
|
Ausgabe 12/2015
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Excerpt
There is a strong temptation to take a reductionist approach that would permit us to assign a single mechanistic cause for ventilation-induced lung injury (VILI) and thereby identify a simple bedside intervention to avoid its consequences. However, convincing investigations have uncovered at least three ways in which adverse tidal cycling pressures may injure the lung: (1) over distension of already inflated alveoli, with cellular distortion, epithelial wounding, and capillary stress fracture [
1]; (2) tidal opening and closure with attendant (or causal) surfactant dysfunction, liquid bridge disruption, and high interfacial surface forces [
2]; and (3) stress focusing/shear at points of micromechanical heterogeneity [
3]. Over the years each has had a spokesperson for its primacy, backed by an impressive body of supportive scientific literature. …