Letter to the Editor
The customization of mechanical ventilation: Yes, but… Keep calm
La personalización de la ventilación mecánica: sí, pero… mantengamos la calma
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This is due to the viscoelastic nature of lung tissue where extracellular matrix components like epithelial/endothelial cells require adaptation time («stress relaxation») to alleviate the tension (stress).<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">Under controlled mechanical ventilation (CMV), the ventilator needs to exceed elastic and resistive forces to trigger respiratory movement. Whichever the model used to explain lung deformation phenomena (strain), time must be taken into consideration in such a way that it should explain why alveoli don’t close immediately or instantaneously fill up with air.<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1,3</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">In this sense, strain rate is referred to as the speed at which a material expands or contracts. Strain rate is inversely associated with time: with the same tension, the longest times (slow changes to the ventilator variables) are associated with lower strain rates. The shortest times, however, (quick changes to the ventilator variables) are associated with higher strain rates. Therefore, quick changes will end up fracturing interstitial alveolar structures following rapid displacement with poor accommodation to static or dynamic efforts. If these changes occur over time, more fractures of alveolar structures will happen as well. However, slow changes preserve interstitial alveolar structure thanks to a greater accommodation to deformation (strain). In time, and although alveoli may be heterogeneous, fractures of alveolar structures will be less likely.<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1,2</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">Therefore, sudden changes to any ventilation parameters whether static or dynamic (changes to tidal volume, positive end-expiratory pressure [PEEP], and inspiratory and expiratory flows) capable of changing deformation (strain) over time, can make ventilation-induced damage worse. This premise turns mechanical power into a particularly appealing variable for the management of ventilation parameters since with the basic equation of movement it includes all potential causes of ventilator-induced lung lesion: tidal volume, conduction pressure, flow, respiratory rate, and PEEP.<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> As a matter of fact, mechanical power keeps a significant correlation with mortality despite adapting to conduction pressure.<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> This proves that mechanical power provides an additional risk estimate beyond conduction pressure <span class="elsevierStyleItalic">per se</span> because it captures the energy applied in a different way compared to conduction pressure.</p><p id="par0030" class="elsevierStylePara elsevierViewall">However, despite the repercussions this can have in the routine clinical practice<a class="elsevierStyleCrossRefs" href="#bib0030"><span class="elsevierStyleSup">6,7</span></a> maybe little attention is being paid to expiratory phase during CMV. The active control of expiratory phase (in modes of flow-controlled ventilation)—providing constant and active gas flow during the entire respiratory cycle whether in inspiration or expiration—minimizes dissipated energy to the lowest possible level, improves lung ventilation in dependent lung regions and, consequently, gas exchange.<a class="elsevierStyleCrossRefs" href="#bib0040"><span class="elsevierStyleSup">8,9</span></a></p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Funding</span><p id="par0035" class="elsevierStylePara elsevierViewall">This manuscript has not received any funding.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Conflicts of interest</span><p id="par0040" class="elsevierStylePara elsevierViewall">None reported.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:3 [ 0 => array:2 [ "identificador" => "sec0005" "titulo" => "Funding" ] 1 => array:2 [ "identificador" => "sec0010" "titulo" => "Conflicts of interest" ] 2 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:9 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Personalized mechanical ventilation in acute respiratory distress syndrome" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "P. 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| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 4 | 5 | 9 |
| 2024 October | 59 | 50 | 109 |
| 2024 September | 56 | 34 | 90 |
| 2024 August | 69 | 44 | 113 |
| 2024 July | 64 | 37 | 101 |
| 2024 June | 47 | 33 | 80 |
| 2024 May | 51 | 28 | 79 |
| 2024 April | 51 | 32 | 83 |
| 2024 March | 44 | 17 | 61 |
| 2024 February | 37 | 33 | 70 |
| 2024 January | 45 | 29 | 74 |
| 2023 December | 43 | 36 | 79 |
| 2023 November | 54 | 42 | 96 |
| 2023 October | 41 | 58 | 99 |
| 2023 September | 31 | 37 | 68 |
| 2023 August | 35 | 14 | 49 |
| 2023 July | 50 | 30 | 80 |
| 2023 June | 52 | 39 | 91 |
| 2023 May | 48 | 38 | 86 |
| 2023 April | 45 | 14 | 59 |
| 2023 March | 48 | 32 | 80 |
| 2023 February | 1 | 0 | 1 |
| 2022 December | 3 | 0 | 3 |
| 2022 November | 1 | 0 | 1 |
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