• Taiki Hoshino and Takeshi Yoshida.
• Department of Anesthesiology and Intensive Care Medicine, Osaka University Graduate School of Medicine, Suita, Japan.
• Curr Opin Crit Care. 2024 Nov 11.

Purpose Of ReviewRecent experimental and clinical studies have suggested that spontaneous effort can potentially injure the lungs. This review summarizes the harmful effects of spontaneous breathing on the lungs during mechanical ventilation in ARDS and suggests potential strategies to minimize spontaneous breathing-induced lung injury.Recent FindingsRecent clinical and experimental studies have shown that vigorous spontaneous breathing during mechanical ventilation can potentially injure the lungs due to high transpulmonary pressure, the Pendelluft phenomenon, increased pulmonary perfusion, and patient-ventilator asynchrony. A definitive approach to minimize spontaneous breathing-induced lung injury is the systemic use of neuromuscular blocking agents; however, there is a risk of muscle atrophy. Alternatively, partial paralysis, bilateral phrenic nerve blockade, and sedatives may be useful for decreasing force generation from the diaphragm while maintaining muscle function. A higher positive end-expiratory pressure (PEEP) and prone positioning may reduce force generation from the diaphragm by decreasing neuromechanical efficiency.SummarySeveral potential strategies, including neuromuscular blockade, partial paralysis, phrenic nerve blockade, sedatives, PEEP, and prone positioning, could be useful to minimize spontaneous breathing-induced lung injury.Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.

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