title: Fifty Years of Research in ARDS. Spontaneous Breathing during Mechanical Ventilation. Risks, Mechanisms, and Management.
abstract: Spontaneous respiratory effort during mechanical ventilation has long been recognized to improve oxygenation, and because oxygenation is a key management target, such effort may seem beneficial. Also, disuse and loss of peripheral muscle and diaphragm function is increasingly recognized, and thus spontaneous breathing may confer additional advantage. Reflecting this, epidemiologic data suggest that the use of partial (vs. full) support modes of ventilation is increasing. Notwithstanding the central place of spontaneous breathing in mechanical ventilation, accumulating evidence indicates that it may cause-or worsen-acute lung injury, especially if acute respiratory distress syndrome is severe and spontaneous effort is vigorous. This Perspective reviews the evidence for this phenomenon, explores mechanisms of injury, and provides suggestions for clinical management and future research.
authors: 1 Translational Medicine.|2 Department of Critical Care Medicine, and.|3 Department of Anesthesia, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada.|4 Intensive Care Unit, Osaka University Hospital, Suita, Japan; and.
authors: Takeshi
authors: T
authors: Yoshida
authors: 4 Intensive Care Unit, Osaka University Hospital, Suita, Japan; and.
authors: Yuji
authors: Y
authors: Fujino
authors: 5 Laboratório de Pneumologia LIM-09, Disciplina de Pneumologia, Heart Institute (InCor) Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil.
authors: Marcelo B P
authors: MB
authors: Amato
authors: 1 Translational Medicine.|2 Department of Critical Care Medicine, and.|3 Department of Anesthesia, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada.
authors: Brian P
authors: BP
authors: Kavanagh
mesh_terms: D006801:Humans; D012119:Respiration; D012121:Respiration, Artificial / Q000009:adverse effects*; D012128:Respiratory Distress Syndrome / Q000150:complications* / Q000503:physiopathology*; D012306:Risk; D055397:Ventilator-Induced Lung Injury / Q000150:complications* / Q000503:physiopathology*
keywords: acute respiratory distress syndrome; mechanical ventilation; spontaneous breathing; ventilator-induced lung injury