[Patient self-inflicted lung injury (P-SILI) : From pathophysiology to clinical evaluation with differentiated management]

The establishment of assisted spontaneous breathing is a phase of ventilation therapy that is generally considered to be beneficial and not dangerous. However, recent findings regarding potential damage from vigorous spontaneous breathing effort should be noticed in patients with acute injured lungs. This syndrome is called patient self-inflicted lung injury. Physicians, nurses and respiratory therapists should be aware of this issue. Parameters that can be determined using esophageal pressure measurement or simple maneuvers on the respirator are helpful when deciding to implement and to monitor assisted spontaneous breathing, even in the acute phases of lung damage. In addition to monitoring, there are therapeutic options for dealing with high respiratory drive or increased breathing effort.