SUPERNOVA: will its energy trigger the formation of a new therapeutic star?

Excerpt

In 1983, Luciano Gattinoni had the vision of a ‘motionless lung’ [1] with the help of an extracorporeal carbon dioxide elimination concept. At that time the term VILI (ventilator induced lung injury) was still far beyond the horizon and no intensivist or respiratory therapist anticipated the consequences of the ARDS Network study from 2000 [2], which began to hold a mirror up to the intensive care community in terms of a protective approach to the injured lung. Did no intensivist or respiratory therapist really anticipate this? The answer is just a few around Gattinoni who stated in 1978 “that patients treated with mechanical ventilation ultimately die, either of the underlying disease process or of complications of pulmonary therapy with mechanical ventilation” [3]. In the late 1990s, a long and partly successful story began on lung protective strategies aimed at saving lives by preventing the deleterious effects of artificial ventilation. Why only partly successful? The answer seems simple, but it is not: the reduction of tidal volume and inspiratory pressure levels was helpful, but it was not the definitive solution to the dilemma between the necessity of mechanical ventilation (to guarantee a life-saving gas exchange) and the attenuation of its harmful effects. In other words, the low tidal volume strategy combined with a limitation of inspiratory pressures went in the right direction, but the clinical scientists continued to ask: “Is there a safe upper limit to inspiratory plateau pressure in patients with ALI/ARDS?” [4]. …