Patient self-inflicted lung injury – does it really exist?

Purpose of review P-SILI (patient self-inflicted lung injury) is a radically new idea based on the claim that patients taking larger tidal volumes (in response to respiratory stimuli) can cause alveolar injury. This review lays bare the lack of robust experimental data to establish the actual existence of P-SILI. Recent findings At the height of the COVID-19 pandemic, world-renowned investigators argued that P-SILI was responsible for much of the lung injury in COVID-19 and recommended radical alterations in ventilator management: avoidance of noninvasive ventilation, preemptive intubation, widespread use of neuromuscular blockers to decrease patient-generated tidal volume, and postponement of ventilator weaning. When debated to provide proof for the existence of P-SILI, proponents imparted sparse unconvincing rejoinders. Summary In a scientific debate, the party making a new claim carries the burden of proof, not the side defending the preexisting state of knowledge (analogous to a defendant's presumption of innocence until evidence is produced to the contrary). Claims for the existence of P-SILI are based on the shakiest of circumstantial evidence. Six decades of research on how to prudently select settings and remove/wean the ventilator at the earliest time were abrogated during a pandemic on the warrant of an unproven hypothetical entity.