• Massimo Cressoni, Miriam Gotti, Chiara Chiurazzi, Dario Massari, Ilaria Algieri, Martina Amini, Antonio Cammaroto, Matteo Brioni, Claudia Montaruli, Klodiana Nikolla, Mariateresa Guanziroli, Daniele Dondossola, Stefano Gatti, Vincenza Valerio, Giordano Luca Vergani, Paola Pugni, Paolo Cadringher, Nicoletta Gagliano, and Luciano Gattinoni.
• From the Dipartimento di Fisiopatologia Medico-Chirurgica e dei Trapianti, Fondazione IRCCS Ca' Granda-Ospedale Maggiore Policlinico, Università degli Studi di Milano, Milan, Italy (M.C., M.G., C.C., D.M., I.A., M.A., A.C., M.B., C.M., K.N., M.G., G.L.V., P.P., P.C.); Centro di Ricerche Precliniche, Fondazione IRCCS Ca' Granda-Ospedale Maggiore Policlinico, Milan, Italy (D.D., S.G.); Department of Anesthesiology and Intensive Care Medicine, Georg-August-University Goettingen, Goettingen, Germany (L.G.); and Dipartimento di Scienze Biomediche per la Salute, Università degli Studi di Milano, Milan, Italy (V.V., N.G.).
• Anesthesiology. 2016 May 1; 124 (5): 1100-8.

BackgroundThe ventilator works mechanically on the lung parenchyma. The authors set out to obtain the proof of concept that ventilator-induced lung injury (VILI) depends on the mechanical power applied to the lung.MethodsMechanical power was defined as the function of transpulmonary pressure, tidal volume (TV), and respiratory rate. Three piglets were ventilated with a mechanical power known to be lethal (TV, 38 ml/kg; plateau pressure, 27 cm H2O; and respiratory rate, 15 breaths/min). Other groups (three piglets each) were ventilated with the same TV per kilogram and transpulmonary pressure but at the respiratory rates of 12, 9, 6, and 3 breaths/min. The authors identified a mechanical power threshold for VILI and did nine additional experiments at the respiratory rate of 35 breaths/min and mechanical power below (TV 11 ml/kg) and above (TV 22 ml/kg) the threshold.ResultsIn the 15 experiments to detect the threshold for VILI, up to a mechanical power of approximately 12 J/min (respiratory rate, 9 breaths/min), the computed tomography scans showed mostly isolated densities, whereas at the mechanical power above approximately 12 J/min, all piglets developed whole-lung edema. In the nine confirmatory experiments, the five piglets ventilated above the power threshold developed VILI, but the four piglets ventilated below did not. By grouping all 24 piglets, the authors found a significant relationship between the mechanical power applied to the lung and the increase in lung weight (r = 0.41, P = 0.001) and lung elastance (r = 0.33, P < 0.01) and decrease in PaO2/FIO2 (r = 0.40, P < 0.001) at the end of the study.ConclusionIn piglets, VILI develops if a mechanical power threshold is exceeded.

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