Ventilator associated lung injury - Revision history

Rossdonaldson1 at 18:34, 24 April 2024

2024-04-24T18:34:49Z

← Older revision		Revision as of 18:34, 24 April 2024
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	===Imaging===		===Imaging===
	[[File:VALI.png\|thumbnail\|right\|ARDS/VALI progression over the course of 1 week		[[File:VALI.png\|thumbnail\|right\|ARDS/VALI progression over the course of 1 week
	(a) Day 1 - No pathological findings. (b) Day 2 - some pulmonary consolidations in lower lobes. (c) Progressing to diffuse alveolar involvement, with “white lung” appearance (d). The normal-sized heart and vascular structures help in the differential diagnosis of pulmonary ~~oedema~~ due to heart failure.<ref ~~name="ESICM"~~>Zompatori M, Ciccarese F, Fasano L. Overview of current lung imaging in acute respiratory distress syndrome. Eur Respir Rev. 2014;23(134):519-30.</ref>]]		(a) Day 1 - No pathological findings. (b) Day 2 - some pulmonary consolidations in lower lobes. (c) Progressing to diffuse alveolar involvement, with “white lung” appearance (d). The normal-sized heart and vascular structures help in the differential diagnosis of pulmonary edema due to heart failure.<ref>Zompatori M, Ciccarese F, Fasano L. Overview of current lung imaging in acute respiratory distress syndrome. Eur Respir Rev. 2014;23(134):519-30.</ref>]]
	*[[CXR]] - increased bilateral interstitial or alveolar opacities of any severity.		*[[CXR]] - increased bilateral interstitial or alveolar opacities of any severity.
	*Computed tomography (CT) - heterogeneous consolidation and atelectasis, as well as focal hyperlucent areas that represent overdistended lung.<ref ~~name="ESICM"~~>International consensus conferences in intensive care medicine: Ventilator-associated Lung Injury in ARDS. This official conference report was cosponsored by the American Thoracic Society, The European Society of Intensive Care Medicine, and The Societé de Réanimation de Langue Française, and was approved by the ATS Board of Directors, July 1999. Am J Respir Crit Care Med 1999; 160:2118.</ref>		*Computed tomography (CT) - heterogeneous consolidation and atelectasis, as well as focal hyperlucent areas that represent overdistended lung.<ref>International consensus conferences in intensive care medicine: Ventilator-associated Lung Injury in ARDS. This official conference report was cosponsored by the American Thoracic Society, The European Society of Intensive Care Medicine, and The Societé de Réanimation de Langue Française, and was approved by the ATS Board of Directors, July 1999. Am J Respir Crit Care Med 1999; 160:2118.</ref>

	==Differential Diagnosis==		==Differential Diagnosis==

Rossdonaldson1: /* Background */

2024-04-24T18:33:17Z

Background

← Older revision		Revision as of 18:33, 24 April 2024
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	==Background==		==Background==
			[[File:Lung and diaphragm.jpg\|thumb\|Lobes of the lung with related anatomy.]]
	*Abbreviation: VALI		*Abbreviation: VALI
	===Terminology===		===Terminology===

ClaireLewis: /* Imaging */

2019-09-27T16:05:39Z

Imaging

← Older revision		Revision as of 16:05, 27 September 2019
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	===Imaging===		===Imaging===
	*[[CXR]]		*[[CXR]]
	*Echocardiography		*[[Echocardiography]]

	===Labs===		===Labs===

ClaireLewis: /* Ventilator Lung Protective SettingsVentilation with lower tidal volumes as compared with traditional tidal volumes for acute lung injury and the acute respiratory distress syndrome. The Acute Respiratory Distress Syndrome Network. N Engl J Med 2000;...

2019-09-27T15:31:08Z

/* Ventilator Lung Protective SettingsVentilation with lower tidal volumes as compared with traditional tidal volumes for acute lung injury and the acute respiratory distress syndrome. The Acute Respiratory Distress Syndrome Network. N Engl J Med 2000;...

← Older revision		Revision as of 15:31, 27 September 2019
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	\| Mode \|\| Assist Control (AC)^		\| Mode \|\| Assist Control (AC)^
	\|-		\|-
	\| Tidal Volume \|\| 6ml/kg of predicted body weight (PBW)		\| Tidal Volume \|\| 6ml/kg of [[predicted body weight]] (PBW)
	\|-		\|-
	\| Respiratory Rate \|\| 12-14bpm		\| Respiratory Rate \|\| 12-14bpm

Rossdonaldson1: /* Ventilator Lung Protective SettingsVentilation with lower tidal volumes as compared with traditional tidal volumes for acute lung injury and the acute respiratory distress syndrome. The Acute Respiratory Distress Syndrome Network. N Engl J Med 2000;...

2019-05-08T06:47:50Z

← Older revision		Revision as of 06:47, 8 May 2019
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	! Setting !! Parameter		! Setting !! Parameter
	\|-		\|-
	\| Mode \|\| Assist Control (AC) ~~- Fully supported mode (rather than partially supported) on either volume (better studied) or pressure control (both acceptable).~~		\| Mode \|\| Assist Control (AC)^
	\|-		\|-
	\| Tidal Volume \|\| 6ml/kg of predicted body weight (PBW)		\| Tidal Volume \|\| 6ml/kg of predicted body weight (PBW)
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	\| Plateau Pressure \|\| ≤30 cm H2O		\| Plateau Pressure \|\| ≤30 cm H2O
	\|}		\|}
			^Fully supported mode (rather than partially supported) on either volume (better studied) or pressure control (both acceptable).

	==Disposition==		==Disposition==

Rossdonaldson1: /* Management by Injury TypeNickson, Chris. "Ventilator Associated Lung Injury (VALI) | LITFL." LITFL Life in the Fast Lane Medical Blog. N.p., n.d. Web. 02 Aug. 2016. */

2019-05-08T06:46:38Z

Management by Injury TypeNickson, Chris. "Ventilator Associated Lung Injury (VALI) | LITFL." LITFL Life in the Fast Lane Medical Blog. N.p., n.d. Web. 02 Aug. 2016.

← Older revision		Revision as of 06:46, 8 May 2019
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	! Injury !! Mechanism !! Management		! Injury !! Mechanism !! Management
	\|-		\|-
	\| Volutrauma & Barotrauma \|\| Over-distension alveoli to pressures ≥ 30 cm H20 causing basement membrane stress \|\| ~~(a.)~~ Maintain Plateau pressure ≤ 30 cm H20		\| Volutrauma & Barotrauma \|\| Over-distension alveoli to pressures ≥ 30 cm H20 causing basement membrane stress \|\|
	~~(b.)~~ Use tidal volume 6ml/kg of PBW (see [[EBQ:ARDSnet Trial]])		*Maintain Plateau pressure ≤ 30 cm H20
			*Use tidal volume 6ml/kg of PBW (see [[EBQ:ARDSnet Trial]])
	\|-		\|-
	\| Biotrauma \|\| Release of chemokines and cytokines cause influx WBC resulting in pulmonary and systemic inflammation and multi-organ dysfunction \|\| ~~(a.)~~ Protective lung ventilation		\| Biotrauma \|\| Release of chemokines and cytokines cause influx WBC resulting in pulmonary and systemic inflammation and multi-organ dysfunction \|\|
	~~(b.) neuromuscular~~ blockers may help.		*Protective lung ventilation
			*Neuromuscular blockers may help.
	\|-		\|-
	\| Atelectotrauma \|\| Repeated alveolar collapse and expansion (RACE) with tidal ventilation will contribute to lung injury. Alveoli especially easy to collapse if edematous \|\| ~~(a.)~~ High PEEP of 5 cm H20		\| Atelectotrauma \|\| Repeated alveolar collapse and expansion (RACE) with tidal ventilation will contribute to lung injury. Alveoli especially easy to collapse if edematous \|\|
	~~(b.)~~ Consider prone positioning		*High PEEP of 5 cm H20
			*Consider prone positioning
	\|-		\|-
	\| Oxygen toxicity \|\| Higher than needed O2 leads to free radicals with cause oxidative injury \|\| ~~(a.)~~ Limit FiO2 and maintain higher PEEP.		\| Oxygen toxicity \|\| Higher than needed O2 leads to free radicals with cause oxidative injury \|\|
	~~(b.)~~ Accept SaO2 at "shoulder" of oxyhaemoglobin dissociation curve (SaO2 88-94%).		*Limit FiO2 and maintain higher PEEP.
			*Accept SaO2 at "shoulder" of oxyhaemoglobin dissociation curve (SaO2 88-94%).
	\|}		\|}

Neil.m.young at 16:28, 1 March 2017

2017-03-01T16:28:02Z

← Older revision		Revision as of 16:28, 1 March 2017
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	===Pathogenesis===		===Pathogenesis===
	*VALI is alveolar injury caused by overexpansion of alveoli (volutrauma), repeated alveolar collapse and expansion (RACE), and cyclic atelectasis		*VALI is alveolar injury caused by overexpansion of alveoli (volutrauma), repeated alveolar collapse and expansion (RACE), and cyclic atelectasis
	*Eventually, in serve VALI/ARDS alveoli edema/bleeding and loss of surfactant can cause complete alveoli collapse<ref name="Rouby">Rouby JJ, Brochard ~~left~~ (2007). "Tidal recruitment and overinflation in acute respiratory distress syndrome: yin and yang.". Am J Respir Crit Care Med 175 (2): 104–6. doi:10.1164/rccm.200610-1564ED. PMID 17200505.</ref>		*Eventually, in serve VALI/ARDS alveoli edema/bleeding and loss of surfactant can cause complete alveoli collapse<ref name="Rouby">Rouby JJ, Brochard L (2007). "Tidal recruitment and overinflation in acute respiratory distress syndrome: yin and yang.". Am J Respir Crit Care Med 175 (2): 104–6. doi:10.1164/rccm.200610-1564ED. PMID 17200505.</ref>

	==Clinical Features==		==Clinical Features==

Neil.m.young: Text replacement - " L " to " left "

2017-02-27T23:58:26Z

Text replacement - " L " to " left "

← Older revision		Revision as of 23:58, 27 February 2017
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	===Pathogenesis===		===Pathogenesis===
	*VALI is alveolar injury caused by overexpansion of alveoli (volutrauma), repeated alveolar collapse and expansion (RACE), and cyclic atelectasis		*VALI is alveolar injury caused by overexpansion of alveoli (volutrauma), repeated alveolar collapse and expansion (RACE), and cyclic atelectasis
	*Eventually, in serve VALI/ARDS alveoli edema/bleeding and loss of surfactant can cause complete alveoli collapse<ref name="Rouby">Rouby JJ, Brochard L (2007). "Tidal recruitment and overinflation in acute respiratory distress syndrome: yin and yang.". Am J Respir Crit Care Med 175 (2): 104–6. doi:10.1164/rccm.200610-1564ED. PMID 17200505.</ref>		*Eventually, in serve VALI/ARDS alveoli edema/bleeding and loss of surfactant can cause complete alveoli collapse<ref name="Rouby">Rouby JJ, Brochard left (2007). "Tidal recruitment and overinflation in acute respiratory distress syndrome: yin and yang.". Am J Respir Crit Care Med 175 (2): 104–6. doi:10.1164/rccm.200610-1564ED. PMID 17200505.</ref>

	==Clinical Features==		==Clinical Features==

Neil.m.young: Reverted edits by Neil.m.young (talk) to last revision by Mholtz

2017-02-27T21:30:55Z

Reverted edits by Neil.m.young (talk) to last revision by Mholtz

← Older revision		Revision as of 21:30, 27 February 2017
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	===Pathogenesis===		===Pathogenesis===
	*VALI is alveolar injury caused by overexpansion of alveoli (volutrauma), repeated alveolar collapse and expansion (RACE), and cyclic atelectasis		*VALI is alveolar injury caused by overexpansion of alveoli (volutrauma), repeated alveolar collapse and expansion (RACE), and cyclic atelectasis
	*Eventually, in serve VALI/ARDS alveoli edema/bleeding and loss of surfactant can cause complete alveoli collapse<ref name="Rouby">Rouby JJ, Brochard ~~left~~ (2007). "Tidal recruitment and overinflation in acute respiratory distress syndrome: yin and yang.". Am J Respir Crit Care Med 175 (2): 104–6. doi:10.1164/rccm.200610-1564ED. PMID 17200505.</ref>		*Eventually, in serve VALI/ARDS alveoli edema/bleeding and loss of surfactant can cause complete alveoli collapse<ref name="Rouby">Rouby JJ, Brochard L (2007). "Tidal recruitment and overinflation in acute respiratory distress syndrome: yin and yang.". Am J Respir Crit Care Med 175 (2): 104–6. doi:10.1164/rccm.200610-1564ED. PMID 17200505.</ref>

	==Clinical Features==		==Clinical Features==

Neil.m.young: Text replacement - " L " to " left "

2017-02-27T20:49:42Z

Text replacement - " L " to " left "

← Older revision		Revision as of 20:49, 27 February 2017
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	===Pathogenesis===		===Pathogenesis===
	*VALI is alveolar injury caused by overexpansion of alveoli (volutrauma), repeated alveolar collapse and expansion (RACE), and cyclic atelectasis		*VALI is alveolar injury caused by overexpansion of alveoli (volutrauma), repeated alveolar collapse and expansion (RACE), and cyclic atelectasis
	*Eventually, in serve VALI/ARDS alveoli edema/bleeding and loss of surfactant can cause complete alveoli collapse<ref name="Rouby">Rouby JJ, Brochard L (2007). "Tidal recruitment and overinflation in acute respiratory distress syndrome: yin and yang.". Am J Respir Crit Care Med 175 (2): 104–6. doi:10.1164/rccm.200610-1564ED. PMID 17200505.</ref>		*Eventually, in serve VALI/ARDS alveoli edema/bleeding and loss of surfactant can cause complete alveoli collapse<ref name="Rouby">Rouby JJ, Brochard left (2007). "Tidal recruitment and overinflation in acute respiratory distress syndrome: yin and yang.". Am J Respir Crit Care Med 175 (2): 104–6. doi:10.1164/rccm.200610-1564ED. PMID 17200505.</ref>

	==Clinical Features==		==Clinical Features==