TY - JOUR
T1 - Propagation prevention
T2 - A complementary mechanism for "lung protective" ventilation in acute respiratory distress syndrome
AU - Marini, John J.
AU - Gattinoni, Luciano
PY - 2008/12
Y1 - 2008/12
N2 - OBJECTIVE: To describe the clinical implications of an often neglected mechanism through which localized acute lung injury may be propagated and intensified. DATA EXTRACTION AND SYNTHESIS: Experimental and clinical evidence from the medical literature relevant to the airway propagation hypothesis and its consequences. CONCLUSIONS: The diffuse injury that characterizes acute respiratory distress syndrome is often considered a process that begins synchronously throughout the lung, mediated by inhaled or blood-borne noxious agents. Relatively little attention has been paid to possibility that inflammatory lung injury may also begin focally and propagate sequentially via the airway network, proceeding mouth-ward from distal to proximal. Were this true, modifications of ventilatory pattern and position aimed at geographic containment of the injury process could help prevent its generalization and limit disease severity. The purposes of this communication are to call attention to this seldom considered mechanism for extending lung injury that might further justify implementation of low tidal volume/high positive end-expiratory pressure ventilatory strategies for lung protection and to suggest additional therapeutic measures implied by this broadened conceptual paradigm.
AB - OBJECTIVE: To describe the clinical implications of an often neglected mechanism through which localized acute lung injury may be propagated and intensified. DATA EXTRACTION AND SYNTHESIS: Experimental and clinical evidence from the medical literature relevant to the airway propagation hypothesis and its consequences. CONCLUSIONS: The diffuse injury that characterizes acute respiratory distress syndrome is often considered a process that begins synchronously throughout the lung, mediated by inhaled or blood-borne noxious agents. Relatively little attention has been paid to possibility that inflammatory lung injury may also begin focally and propagate sequentially via the airway network, proceeding mouth-ward from distal to proximal. Were this true, modifications of ventilatory pattern and position aimed at geographic containment of the injury process could help prevent its generalization and limit disease severity. The purposes of this communication are to call attention to this seldom considered mechanism for extending lung injury that might further justify implementation of low tidal volume/high positive end-expiratory pressure ventilatory strategies for lung protection and to suggest additional therapeutic measures implied by this broadened conceptual paradigm.
KW - Acute respiratory distress syndrome
KW - Secretions
KW - Ventilatorinduced lung injury
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U2 - 10.1097/CCM.0b013e31818f0e68
DO - 10.1097/CCM.0b013e31818f0e68
M3 - Review article
C2 - 18936705
AN - SCOPUS:58149240647
SN - 0090-3493
VL - 36
SP - 3252
EP - 3258
JO - Critical care medicine
JF - Critical care medicine
IS - 12
ER -