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Review
. 2025 Feb 27;14(5):1632.
doi: 10.3390/jcm14051632.

Patient-Self Inflicted Lung Injury (P-SILI): An Insight into the Pathophysiology of Lung Injury and Management

Himanshu Deshwal  1 , Ahmed Elkhapery  2 , Rudra Ramanathan  3 , Deepak Nair  4 , Isha Singh  5 , Ankur Sinha  6 , Rishik Vashisht  7 , Vikramjit Mukherjee  8
Affiliations
Review

Patient-Self Inflicted Lung Injury (P-SILI): An Insight into the Pathophysiology of Lung Injury and Management

Himanshu Deshwal et al. J Clin Med. .

Abstract

Acute respiratory distress syndrome (ARDS) is a heterogeneous group of disease entities that are associated with acute hypoxic respiratory failure and significant morbidity and mortality. With a better understanding and phenotyping of lung injury, novel pathophysiologic mechanisms demonstrate the impact of a patient's excessive spontaneous breathing effort on perpetuating lung injury. Patient self-inflicted lung injury (P-SILI) is a recently identified phenomenon that delves into the impact of spontaneous breathing on respiratory mechanics in patients with lung injury. While the studies are hypothesis-generating and have been demonstrated in animal and human studies, further clinical trials are needed to identify its impact on ARDS management. The purpose of this review article is to highlight the physiologic mechanisms of P-SILI, novel tools and methods to detect P-SILI, and to review the current literature on non-invasive and invasive respiratory management in patients with ARDS.

Keywords: acute hypoxic respiratory failure (AHRF); acute respiratory distress syndrome (ARDS); lung protective mechanical ventilation; patient self-inflicted lung injury (P-SILI).

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Conflict of interest statement

The authors declare no conflicts of interest.

Figures

Figure 1
Figure 1
The pathophysiologic mechanism of P-SILI. (Created in BioRender. Hashem, A. (2025) https://BioRender.com/v70d189, accessed on 20 February 2025).
Figure 2
Figure 2
Management approach to acute hypoxic respiratory failure and P-SILI.
See this image and copyright information in PMC

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