What is Ventilator Induced Lung Injury (VILI)?
Ventilator Induced Lung Injury (VILI) refers to the lung damage that occurs as a result of mechanical ventilation. While mechanical ventilation is a lifesaving intervention for children with respiratory failure, it can also cause injury to the delicate lung tissues. VILI can manifest in various forms including barotrauma, volutrauma, atelectrauma, and biotrauma.
Barotrauma: Damage caused by excessive pressure in the lungs.
Volutrauma: Injury due to excessive volume and overdistension of the alveoli.
Atelectrauma: Injury resulting from repetitive opening and closing of collapsed alveoli.
Biotrauma: Inflammatory injury at the cellular level due to mechanical stress.
Pre-existing
lung conditions such as bronchopulmonary dysplasia.
High ventilator settings, especially high positive end-expiratory pressure (PEEP) and tidal volume.
Prolonged duration of mechanical ventilation.
Underlying
systemic diseases like sepsis or congenital heart disease.
Decreased oxygenation and increased need for supplemental oxygen.
Increased respiratory effort and distress.
Development of pulmonary edema and hypoxemia.
Radiographic evidence of lung injury, such as infiltrates or
pneumothorax.
Monitoring changes in
oxygenation and ventilatory parameters.
Regular chest X-rays to identify new infiltrates or air leaks.
Assessment of inflammatory markers, although these are not specific to VILI.
Using lung-protective ventilation strategies like low tidal volume and optimal PEEP settings.
Implementing
permissive hypercapnia to avoid high ventilation pressures.
Early weaning from mechanical ventilation to minimize exposure.
Using adjunctive therapies such as surfactant replacement and
inhaled nitric oxide in specific cases.
Conclusion
Ventilator Induced Lung Injury is a significant concern in pediatric critical care. Understanding the mechanisms, risk factors, and management strategies is essential for improving patient outcomes and minimizing the adverse effects of mechanical ventilation.
