• John N Cronin and Federico Formenti.
• Centre for Human and Applied Physiological Sciences, School of Basic and Medical Biosciences, King's College London, London, UK; Department of Anaesthesia, Guy's and St Thomas' NHS Foundation Trust, London, UK.
• Br J Anaesth. 2023 Jan 1; 130 (1): e44e46e44-e46.

AbstractPatient self-inflicted lung injury may be associated with worse clinical outcomes and higher mortality. Patient-ventilator asynchrony is associated with increased ventilator days and mortality, and it has been hypothesised as one of the important mechanisms leading to patient self-inflicted lung injury. However, given the observational nature of the key studies in the field so far, the hypothesis that patient-ventilator asynchrony causes patient self-inflicted lung injury has not been supported by evidence yet. Wittenstein and colleagues present a novel approach that enables controlling patient-ventilator asynchrony in a pig model of acute lung injury, to investigate the patient-ventilator asynchrony and patient self-inflicted lung injury causality. Their results suggest that increased patient-ventilator asynchrony associated with poor clinical outcomes reported in observational trials could be a marker, rather than a cause of patient self-inflicted lung injury. These findings on their own are not sufficient to justify a greater tolerance of patient-ventilator asynchrony amongst clinicians, a change for which further experimental work and clinical evidence is needed.Copyright © 2021 British Journal of Anaesthesia. Published by Elsevier Ltd. All rights reserved.

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