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Editorials |

Inspiratory Efforts During Mechanical Ventilation: Is There Risk of Barotrauma?

Stephen H. Loring, MD; Atul Malhotra, MD, FCCP
Author and Funding Information

Affiliations: Boston, MA ,  Dr. Loring is Associate Professor, Beth Israel Deaconess Medical Center and Harvard Medical School. Dr. Malhotra is Assistant Professor, Brigham and Women’s Hospital, Beth Israel Deaconess Hospital, and Harvard Medical School.

Correspondence to: Stephen H. Loring, MD, Beth Israel Deaconess Medical Center and Harvard Medical School, Department of Anesthesia, 330 Brookline Ave, DA 717, Boston, MA 02215; e-mail: sloring@bidmc.harvard.edu



Chest. 2007;131(3):646-648. doi:10.1378/chest.06-2782
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A growing body of literature suggests that mechanical ventilation can promote lung damage when excessive transpulmonary pressures are applied.1 Although stretch-mediated lung injury has received much attention,2 lung hyperinflation leading to gross barotrauma is also a concern, particularly if lung volume exceeds total lung capacity (TLC). Human lungs are normally prevented from overdistension by the felicitous match between maximal inspiratory muscle pressures (Pmus-max) and the pressures required to inflate the respiratory system to its maximal volume (ie, TLC). This protective equilibrium may not apply to patients making forceful inspiratory efforts on mechanical ventilation, especially during pressure-control or pressure-support ventilation when applied pressures could conceivably combine with Pmus-max to overdistend the lungs.

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