Concept of Lung Protection
- “Mechanical ventilation is a life-saving therapy that can kill the lung.”1
- Ventilation using positive pressure is never physiological.
- IMV triggers cascades of pathophysiological processes which can cause additional lung damage (VALI/VILI)
- Under mechanical ventilation, the breathing muscles begin to degenerate within a very short space of time (Ventilator Induced Diaphragm Dysfunction, VIDD)
- Prevention of intubation is the only protection from ventilation-induced lung damage
- The aim of the concept of ventilation providing lung protection is to keep the strain on the lungs during IMV as low as possible.
iLA therapies pave the way to real lung protection:
Relief to the respiratory system is provided, and ventilation settings (tidal volume, respiratory rate, and respiratory pressure) are de-escalated. The membrane ventilator “breathes” on behalf of the patient outside the patient’s body and assists the native lung with some of the gas exchange work. The lung is given time to heal. Extracorporeal CO2 removal, which reduces the need for mechanical ventilation for the patient, can potentially prevent the side effects of mechanical ventilation altogether.2 If initiated early on, interventional lung support (iLA therapy) can prevent intubation.3, 4
1 Pesenti A. Crit Care Med 2010; 38 (Suppl): S549-S554
2 Muellenbach RM et al. Eur J Anaesthesiol 2008;25:897-904
3 Kluge S et al. Intensive Care Med 2012; 38(10):1632-1639
4 Brederlau J et al. Eur Respir J 2012; 40(3):783-785