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Review
. 2021 Oct;116(7):614-623.
doi: 10.1007/s00063-021-00823-2. Epub 2021 May 7.

[Patient self-inflicted lung injury (P-SILI) : From pathophysiology to clinical evaluation with differentiated management]

[Article in German]
Benjamin Neetz  1 , Thomas Flohr  2 , Felix J F Herth  3 , Michael M Müller  3
Affiliations
Review

[Patient self-inflicted lung injury (P-SILI) : From pathophysiology to clinical evaluation with differentiated management]

[Article in German]
Benjamin Neetz et al. Med Klin Intensivmed Notfmed. 2021 Oct.

Abstract
in English, German

The establishment of assisted spontaneous breathing is a phase of ventilation therapy that is generally considered to be beneficial and not dangerous. However, recent findings regarding potential damage from vigorous spontaneous breathing effort should be noticed in patients with acute injured lungs. This syndrome is called patient self-inflicted lung injury. Physicians, nurses and respiratory therapists should be aware of this issue. Parameters that can be determined using esophageal pressure measurement or simple maneuvers on the respirator are helpful when deciding to implement and to monitor assisted spontaneous breathing, even in the acute phases of lung damage. In addition to monitoring, there are therapeutic options for dealing with high respiratory drive or increased breathing effort.

Die Etablierung der unterstützten Spontanatmung gilt allgemein als eine vorteilhafte und wenig gefährdende Phase der Beatmungstherapie. Allerdings geben neuere Erkenntnisse Hinweise auf eine potenzielle Schädigung durch exzessive Spontanatembemühungen vor allem bei akuter Lungenschädigung. Das Syndrom wird unter dem Begriff „patient self-inflicted lung injury“ zusammengefasst. Ärzte, Pflegepersonen und Atmungstherapeuten sollten für diese Thematik sensibilisiert werden. Parameter, die mittels Ösophagusdruckmessung oder einfacher Manöver am Respirator bestimmt werden können, sind bei der Entscheidung zur Durchführung und zur Überwachung von Spontanatmung auch in den akuten Phasen der Lungenschädigung hilfreich. Weiterhin gibt es im Umgang mit hohem Atemantrieb oder erhöhter Atemanstrengung therapeutische Möglichkeiten, diesen zu begegnen.

Keywords: Assisted spontaneous breathing; Breathing effort; Lung stress; Respiratory effort; Ventilator-induced lung injury.

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