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01-12-2015 | Editorial

Does high-pressure, high-frequency oscillation shake the foundations of lung protection?

Author: John J. Marini

Published in: Intensive Care Medicine | Issue 12/2015

Excerpt

There is a strong temptation to take a reductionist approach that would permit us to assign a single mechanistic cause for ventilation-induced lung injury (VILI) and thereby identify a simple bedside intervention to avoid its consequences. However, convincing investigations have uncovered at least three ways in which adverse tidal cycling pressures may injure the lung: (1) over distension of already inflated alveoli, with cellular distortion, epithelial wounding, and capillary stress fracture [1]; (2) tidal opening and closure with attendant (or causal) surfactant dysfunction, liquid bridge disruption, and high interfacial surface forces [2]; and (3) stress focusing/shear at points of micromechanical heterogeneity [3]. Over the years each has had a spokesperson for its primacy, backed by an impressive body of supportive scientific literature. …

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Title: Does high-pressure, high-frequency oscillation shake the foundations of lung protection?
Author: John J. Marini
Publication date: 01-12-2015
Publisher: Springer Berlin Heidelberg
Published in: Intensive Care Medicine / Issue 12/2015
Print ISSN: 0342-4642
Electronic ISSN: 1432-1238
DOI: https://doi.org/10.1007/s00134-015-4111-8

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Does high-pressure, high-frequency oscillation shake the foundations of lung protection?

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