Editorial Views  |   June 2018
Energetics and the Root Mechanical Cause for Ventilator-induced Lung Injury
Author Notes
  • From the Department of Pulmonary and Critical Care Medicine, Regions Hospital and University of Minnesota, Minneapolis/St. Paul, Minnesota (J.J.M.); and the Department of Anesthesiology, University of Göttingen, Göttingen, Germany (L.G.).
  • Corresponding article on page 1193.
    Corresponding article on page 1193.×
  • Accepted for publication February 27, 2018.
    Accepted for publication February 27, 2018.×
  • Address correspondence to Dr. Marini: marin002@umn.edu
Article Information
Editorial Views / Critical Care / Respiratory System
Editorial Views   |   June 2018
Energetics and the Root Mechanical Cause for Ventilator-induced Lung Injury
Anesthesiology 6 2018, Vol.128, 1062-1064. doi:10.1097/ALN.0000000000002203
Anesthesiology 6 2018, Vol.128, 1062-1064. doi:10.1097/ALN.0000000000002203
SINCE the discovery that acute lung injury could be worsened by unwise choices for mechanical ventilation, investigators have sought the mechanisms and clinical parameters that initiate such damage (ventilator-induced lung injury).1  Our understanding has progressed from simply confining tidal volumes to fixed guideline values to limiting the plateau and driving pressures of the tidal cycle. But damage requires energy and ventilator-induced lung injury is not caused by single deep inflations. Recent attention has logically (if somewhat belatedly) turned toward better defining the place of ventilation frequency and cumulative energy load delivered to the lung over the span of multiple cycles.2  Such loading has been described as “power,” a variable related to exposure intensity that quantifies energy imparted per minute and includes all mechanical factors shown experimentally to influence ventilator-induced lung injury. The root mechanical cause that initiates ventilator-induced lung injury at the tissue level, however, remains elusive. Laboratory work reported by Santos et al. in this issue of A nesthesiology3  helps enlighten by demonstrating that tidal pressures and power have overlapping influence on development of biomarker-detected inflammation and histologic changes.
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