Published in:
Open Access
01-12-2018 | Editorial
Volutrauma and atelectrauma: which is worse?
Authors:
Luciano Gattinoni, Michael Quintel, John J. Marini
Published in:
Critical Care
|
Issue 1/2018
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Excerpt
The first recognized form of ventilator-induced lung injury (VILI) was named barotrauma, a word that stresses the role of pressure as a causative agent [
1]. Following the work of Dreyfuss et al., which called attention to volume instead of pressure [
2], volutrauma was recognized as the primary driver of VILI. While airway pressure distributes across the series-linked thoracic cage and lungs in proportions determined by their relative elastances, volume is a unique variable common to both. Any conceptual distinction between volutrauma and barotrauma vanishes if one considers transpulmonary pressure (PL; stress) instead of airway pressure, and strain (i.e., volume change (∆V) relative to resting lung volume (functional residual capacity (FRC)) instead of tidal volume [
3]. These two variables are inextricably coupled by a proportionality constant having the units of pressure (specific elastance, or E
spec), which in man approximates 12–13 cmH
2O [
4]:
$$ Stress=k\bullet Strain $$
or
$$ PL={E}_{spec}\bullet \frac{\Delta V}{FRC} $$
…