Propagation prevention: A complementary mechanism for "lung protective" ventilation in acute respiratory distress syndrome

John J. Marini, Luciano Gattinoni

Research output: Contribution to journalArticle

Abstract

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.

Original languageEnglish
Pages (from-to)3252-3258
Number of pages7
JournalCritical Care Medicine
Volume36
Issue number12
DOIs
Publication statusPublished - Dec 2008

Fingerprint

Adult Respiratory Distress Syndrome
Lung Injury
Ventilation
Lung
Positive-Pressure Respiration
Acute Lung Injury
Tidal Volume
Wounds and Injuries
Mouth
Therapeutics

Keywords

  • Acute respiratory distress syndrome
  • Secretions
  • Ventilatorinduced lung injury

ASJC Scopus subject areas

  • Critical Care and Intensive Care Medicine

Cite this

Propagation prevention : A complementary mechanism for "lung protective" ventilation in acute respiratory distress syndrome. / Marini, John J.; Gattinoni, Luciano.

In: Critical Care Medicine, Vol. 36, No. 12, 12.2008, p. 3252-3258.

Research output: Contribution to journalArticle

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