Abstract
BackgroundVentilator-induced lung injury is a form of mechanical damage leading to a pulmonary inflammatory response related to the use of mechanical ventilation enhanced by the presence of atelectasis. One proposed mechanism of this injury is the repetitive opening and closing of collapsed alveoli and small airways within these atelectatic areas—a phenomenon called tidal recruitment. The presence of tidal recruitment is difficult to detect, even with high-resolution images of the lungs like CT scan. The purpose of this article is to give evidence of tidal recruitment by lung ultrasound.FindingsA standard lung ultrasound inspection detected lung zones of atelectasis in mechanically ventilated patients. With a linear probe placed in the intercostal oblique position. We observed tidal recruitment within atelectasis as an improvement in aeration at the end of inspiration followed by the re-collapse at the end of expiration. This mechanism disappeared after the performance of a lung recruitment maneuver.ConclusionsLung ultrasound was helpful in detecting the presence of atelectasis and tidal recruitment and in confirming their resolution after a lung recruitment maneuver.Electronic supplementary materialThe online version of this article (doi:10.1186/s13089-015-0036-2) contains supplementary material, which is available to authorized users.
Highlights
Ventilator-induced lung injury is a form of mechanical damage leading to a pulmonary inflammatory response related to the use of mechanical ventilation enhanced by the presence of atelectasis
Lung ultrasound was helpful in detecting the presence of atelectasis and tidal recruitment and in con‐ firming their resolution after a lung recruitment maneuver
The resultant high tissue stress in these atelectatic zones, and especially in the boundary areas between collapsed and open lung areas, can trigger a local inflammatory response and injure the alveolar–capillary membrane [3]. This is one of the proposed mechanisms of ventilator-induced lung injury (VILI) that impairs the outcome of patients with acute respiratory distress syndrome [1,2,3,4]
Summary
Ventilator-induced lung injury is a form of mechanical damage leading to a pulmonary inflammatory response related to the use of mechanical ventilation enhanced by the presence of atelectasis. The other mechanism of VILI is tidal overinflation that could appear in some ventral areas of the lungs at the end of inspiration [5]. The use of a lung protective ventilatory strategy resulted in a significant decrease in mortality in ARDS patients by the reduction of VILI during mechanical ventilation [4].
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