Patient self-inflicted lung injury and ultraprotective mechanical ventilation: a narrative review

Patient self-inflicted lung injury (P-SILI) describes the contribution of the patient's own respiratory effort to lung damage during mechanical ventilation (MV). Ultraprotective mechanical ventilation (UMV) and physiology-guided invasive monitoring may reduce its occurrence. The objective was to review the pathophysiology of P-SILI, define the concept of UMV, and analyzecurrent evidence regarding its clinical use.P-SILI arises from increased lung stress and strain during vigorous inspiratory effort, aggravated edema due to negative transcapillary pressures, and patient-ventilator asynchrony.UMV aims to reduce these mechanisms using lower tidal volumes and plateau pressures than standard protective ventilation (< 6 mL/kg predicted body weight, < 25 cmH 2 O), decreasing stress applied to lung tissue.As conclusion, P-SILI represents a key driver of acute lung injury progression.UMV emerges as a strategy to mitigate this phenomenon, although its optimal implementation and impact on clinical outcomes require further validation in controlled trials.