Acute respiratory distress syndrome (ARDS) is characterized by severe hypoxemia, low lung compliance, and marked regional heterogeneity of aeration, making the lung highly vulnerable to injurious mechanical forces. Mechanical ventilation is essential to maintain gas exchange. However, excessive stress and strain may contribute to ventilator-induced lung injury (VILI). The progressive transition to partial ventilatory support introduces an additional risk: patient self-inflicted lung injury (P-SILI), driven by vigorous inspiratory efforts, large transpulmonary pressure swings, pendelluft, and heterogeneous regional strain. Advances in monitoring, imaging, and physiology-based management offer the potential to reduce lung injury and improve outcomes in mechanically ventilated patients with ARDS. This review aims to summarize the clinical–physiological background of VILI and P-SILI, describe protective strategies during controlled and partially assisted ventilation, and discuss monitoring tools to personalize mechanical ventilation in ARDS.
Cornejo et al. (Fri,) studied this question.