Lesión pulmonar autoinducida por el paciente (P-SILI)

Abstract

The article reviews the scientific literature on Patient Self-Induced Lung Injury (P-SILI) in patients with Acute Respiratory Distress Syndrome (ARDS). It begins with a history since 1985, highlighting events of pulmonary edema related to hyperventilation in diabetic patients and advances in the understanding of pulmonary mechanics. Experimental studies in sheep and humans are detailed that show lung damage due to hyperventilation, highlighting the importance of spontaneous ventilation and alveolar damage. In addition, studies on alveolar hemorrhage post-intense exercise in animals and high-performance athletes are mentioned. The text explores the relationship between Invasive Mechanical Ventilation (IMV) and lung injury, addressing therapeutic strategies such as neuromuscular blockade and the impact of positive end-expiratory pressure (PEEP). The theoretical mechanisms of P-SILI are delved into, highlighting pulmonary overdistension, increased pulmonary perfusion and patient-ventilator asynchronies. The clinical impact of P-SILI, especially in patients with COVID-19 and ARDS, is discussed, and management strategies such as high-flow oxygen therapy are highlighted. The article concludes by highlighting the need for more studies to standardize the monitoring of inspiratory efforts, understand its implication in prognosis and guide appropriate therapy, recognizing that the optimal approach is still the subject of debate.