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Journal Club: Mechanical power and the reduction of VILI

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作者: Marcia Correia Abreu dos Santos

日期: 16.04.2020

Last change: 20.02.2023

Changed categorization to exclude Application

Mechanical power has become a hot topic in discussions about optimizing ventilator settings for critically ill patients.

Journal Club: Mechanical power and the reduction of VILI

The power of mechanical power

Defined as the amount of energy transferred from the ventilator to the respiratory system within a given timeframe, mechanical power has been related to the degree of ventilator-induced lung injury. In our Journal Club review, we look at what contributes to mechanical power, how to quantify it at the bedside and its relevance for applying lung-protective ventilation. The discussion in the video available below is based on the 2019 publication "Power to mechanical power to minimize ventilator-induced lung injury?". Silva PL, Ball L, Rocco PRM, Pelosi P. Power to mechanical power to minimize ventilator-induced lung injury?. Intensive Care Med Exp. 2019;7(Suppl 1):38. Published 2019 Jul 25. doi:10.1186/s40635-019-0243-41

Power to mechanical power to minimize ventilator-induced lung injury?

Silva PL, Ball L, Rocco PRM, Pelosi P. Power to mechanical power to minimize ventilator-induced lung injury?. Intensive Care Med Exp. 2019;7(Suppl 1):38. Published 2019 Jul 25. doi:10.1186/s40635-019-0243-4

Mechanical ventilation is a life-supportive therapy, but can also promote damage to pulmonary structures, such as epithelial and endothelial cells and the extracellular matrix, in a process referred to as ventilator-induced lung injury (VILI). Recently, the degree of VILI has been related to the amount of energy transferred from the mechanical ventilator to the respiratory system within a given timeframe, the so-called mechanical power. During controlled mechanical ventilation, mechanical power is composed of parameters set by the clinician at the bedside-such as tidal volume (VT), airway pressure (Paw), inspiratory airflow (V'), respiratory rate (RR), and positive end-expiratory pressure (PEEP) level-plus several patient-dependent variables, such as peak, plateau, and driving pressures. Different mathematical equations are available to calculate mechanical power, from pressure-volume (PV) curves to more complex formulas which consider both dynamic (kinetic) and static (potential) components; simpler methods mainly consider the dynamic component. Experimental studies have reported that, even at low levels of mechanical power, increasing VT causes lung damage. Mechanical power should be normalized to the amount of ventilated pulmonary surface; the ratio of mechanical power to the alveolar area exposed to energy delivery is called "intensity." Recognizing that mechanical power may reflect a conjunction of parameters which may predispose to VILI is an important step toward optimizing mechanical ventilation in critically ill patients. However, further studies are needed to clarify how mechanical power should be taken into account when choosing ventilator settings.

以前版本 Journal Club: Mechanical power and the reduction of VILI

视频
Journal Club: Reduce mechanical power to minimize VILI
英语