by Alessandro Marchioni, Roberto Tonelli, Giulio Rossi,
Paolo Spagnolo, Fabrizio Luppi, Stefania Cerri, Elisabetta Cocconcelli, Maria
Rosaria Pellegrino, Riccardo Fantini, Luca Tabbì, Ivana Castaniere, Lorenzo
Ball, Manu L. N. G. Malbrain, Paolo Pelosi and Enrico Clini
Annals of Intensive Care volume 10,
Article number: 13 (2020)
Protective ventilation is the cornerstone of treatment of
patients with the acute respiratory distress syndrome (ARDS); however, no
studies have yet established the best ventilatory strategy to adopt when
patients with acute exacerbation of interstitial lung disease (AE-ILD) are
admitted to the intensive care unit. Due to the severe impairment of the
respiratory mechanics, the fibrotic lung is at high risk of developing
ventilator-induced lung injury, regardless of the lung fibrosis etiology. The
purpose of this review is to analyze the effects of mechanical ventilation in
AE-ILD and to increase the knowledge on the characteristics of fibrotic lung
during artificial ventilation, introducing the concept of “squishy ball lung”.
The role of positive end-expiratory pressure is discussed, proposing a “lung
resting strategy” as opposed to the “open lung approach”. The review also
discusses the practical management of AE-ILD patients discussing illustrative
clinical cases.
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