Koutsoukou A, Pecchiari M. Expiratory flow-limitation in mechanically ventilated patients: A risk for ventilator-induced lung injury? World J Crit Care Med 2019; 8(1): 1-8 [PMID: 30697515 DOI: 10.5492/wjccm.v8.i1.1]
Corresponding Author of This Article
Antonia Koutsoukou, PhD, Professor, ICU, 1st Department of Respiratory Medicine, National and Kapodistrian University of Athens Medical School, “Sotiria” Hospital for Diseases of the Chest, 152 Mesogion Av, Athens 11527, Greece. koutsoukou@yahoo.gr
Research Domain of This Article
Critical Care Medicine
Article-Type of This Article
Editorial
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Crit Care Med. Jan 23, 2019; 8(1): 1-8 Published online Jan 23, 2019. doi: 10.5492/wjccm.v8.i1.1
Expiratory flow-limitation in mechanically ventilated patients: A risk for ventilator-induced lung injury?
Antonia Koutsoukou, Matteo Pecchiari
Antonia Koutsoukou, ICU, 1st Department of Respiratory Medicine, National and Kapodistrian University of Athens Medical School, Athens 11527, Greece
Matteo Pecchiari, Dipartimento di Fisiopatologia e dei Trapianti, Università degli Studi di Milano, Milan 20133, Italy
Author contributions: Koutsoukou A conceived the study; Koutsoukou A and Pecchiari M drafted the manuscript; both authors approved the final version of the article.
Conflict-of-interest statement: The authors have no conflict of interest to declare.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Antonia Koutsoukou, PhD, Professor, ICU, 1st Department of Respiratory Medicine, National and Kapodistrian University of Athens Medical School, “Sotiria” Hospital for Diseases of the Chest, 152 Mesogion Av, Athens 11527, Greece. koutsoukou@yahoo.gr
Telephone: +30-210-7763718 Fax: +30-210-7781250
Received: July 13, 2018 Peer-review started: July 13, 2018 First decision: August 3, 2018 Revised: August 24, 2018 Accepted: October 17, 2018 Article in press: October 17, 2018 Published online: January 23, 2019 Processing time: 194 Days and 21.3 Hours
Core Tip
Core tip: Expiratory flow limitation (EFL), the inability of expiratory flow to increase despite increasing driving pressure, is a common unrecognized occurrence during mechanical ventilation in a variety of intensive care unit conditions. It implies cyclic compression/decompression of the airways, is associated with intrinsic positive end-expiratory pressure (PEEPi) and inhomogeneous filling, and is often concomitant with cyclic recruitment/derecruitment. In acute respiratory distress syndrome, the development of abnormally high stresses is potentially injurious for the lung. External PEEP abolishes EFL and decreases ventilation and intrinsic PEEP heterogeneity, improving gas exchange. Moreover, external PEEP prevents cyclic airway collapse/reopening, possibly protecting the parenchyma from low lung volume ventilator-induced lung injury.
