How I optimize power to avoid VILI

Excerpt

Mechanical ventilation is an inherently dynamic process. Nonetheless, tidal volume and static tidal airway pressures (plateau, PEEP, and their difference, the driving pressure) have long served as the primary variables guiding prevention of ventilator-induced lung injury (VILI). Despite their prominence in current practice, such non-dynamic pressures cannot act alone to inflict damage; a pressure must be paired with a volume change, thereby expending energy. More specifically, any instigator of damage couples pressure applied directly to the lung, i.e., transpulmonary pressure (stress), to the associated change of lung volume (strain). Because damage depends not only on the frequency of such pairings but also on the rate of tidal stress/strain development across the epithelium and within individual extracellular fibrils that oppose lung expansion, rapid flows accentuate VILI hazard [1, 2]. …