Abstract
From literature we know that a cornerstone of the protective lung ventilation in Acute Respiratory Distress Syndrome (ARDS) patients[1] and during general anesthesia[2] is a low tidal volume. On the other hand, driving pressure seems to be the variable that best stratifies mortality risk[3]. Our hypothesis is that the combination of volume and pressure, that is the energy dissipated into respiratory system, is the main determinant of a ventilator-induced lung injury (VILI).
Highlights
From literature we know that a cornerstone of the protective lung ventilation in Acute Respiratory Distress Syndrome (ARDS) patients [1] and during general anesthesia [2] is a low tidal volume
We measured dissipated energy in each breaths by the hysteresis area of the PV curve of the respiratory system; we calculated the total dissipated energy into respiratory system multiplying energy dissipated during every breath by the respiratory rate
In the 3 groups considered, the total dissipated energy is greater during 12 ml/kg if compared to 6 ml/kg ventilation, in particular: ARDS patients 7.60 [6.32-8.78] J/min VS 6.06 [4.577.12] J/min (p < 0.001), obese patients 8.71 [7.69-10.98] J/min VS 7.35 [6.68-10.52] J/min (p < 0.001), healthy lungs patients 5.04 [3.48-6.67] J/min VS 4.02 [3.18-4.85] J/min (p < 0.001) (Wilcoxon matched pairs test)
Summary
From literature we know that a cornerstone of the protective lung ventilation in Acute Respiratory Distress Syndrome (ARDS) patients [1] and during general anesthesia [2] is a low tidal volume. On the other hand, driving pressure seems to be the variable that best stratifies mortality risk [3]. Our hypothesis is that the combination of volume and pressure, that is the energy dissipated into respiratory system, is the main determinant of a ventilator-induced lung injury (VILI)
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