Are we prepared to monitor and prevent patient self-inflicted lung injury (P-SILI) during mechanical ventilation in pediatric patients?

Souza, João Marcos Feliciano de; Amato, Marcelo Britto Passos; Costa, Eduardo Leite Vieira; Troster, Eduardo Juan

doi:10.31744/einstein_journal/2025CE1522

Dear Editor,

Acute respiratory failure (ARF) is a leading cause of pediatric hospitalizations, and invasive mechanical ventilation (IMV) is an essential support in severe cases.(¹) Data obtained through expiratory and inspiratory pause maneuvers on mechanical ventilators during spontaneous breathing in adult IMV patients have been shown to aid prevention of patient self-inflicted lung injury (P-SILI).(²,³)

The scarcity of pediatric-specific data complicates the monitoring and prevention of comorbidities associated with P-SILI. Understanding and incorporating measures (Figure 1) such as occlusion pressure in the first millisecond (P.01), variation in occlusion pressure (ΔPocc), inspiratory muscle pressure (Pmus), Pressure Muscular Index (PMI), and dynamic transpulmonary driving pressure (ΔPL, dyn) into routine ventilatory care may represent a significant step toward reducing morbidity and mortality in pediatric patients.(⁴,⁵)

Figure 1
Mechanical ventilation chart taken during pressure support ventilation

Therefore, there is an urgent need to assess whether we are prepared to monitor and prevent P-SILI by adopting protective strategies based on pulmonary mechanics.

REFERENCES

¹ Friedman ML, Nitu ME. Acute respiratory failure in children. Pediatr Ann. 2018;47(7):e268-e273. Review.
² Bertoni M, Telias I, Urner M, Long M, Del Sorbo L, Fan E, et al. A novel non-invasive method to detect excessively high respiratory effort and dynamic transpulmonary driving pressure during mechanical ventilation. Crit Care. 2019;23(1):346.
³ Marongiu I, Slobod D, Leali M, Spinelli E, Mauri T. Clinical and experimental evidence for patient self-inflicted lung injury (P-SILI) and bedside monitoring. J Clin Med. 2024;13(14):4018. Review.
⁴ Goligher EC, Dres M, Patel BK, Sahetya SK, Beitler JR, Telias I, et al. Lung- and diaphragm-protective ventilation. Am J Respir Crit Care Med. 2020;202(7):950-61.
⁵ Vedrenne-Cloquet M, Ito Y, Hotz J, Klein MJ, Herrera M, Chang D, et al. Phenotypes based on respiratory drive and effort to identify the risk factors when P0.1 fails to estimate ΔPES in ventilated children. Crit Care. 2024;28(1):325.

Associate Editor:
Claudio Roberto Cernea Hospital Israelita Albert Einstein, São Paulo, SP, Brazil ORCID: https://orcid.org/0000-0001-5899-0535

Publication Dates

Publication in this collection
17 Feb 2025
Date of issue
2025

History

Received
21 Nov 2024
Accepted
29 Nov 2024

This content is licensed under a Creative Commons Attribution 4.0 International License.

[1] ¹ Friedman ML, Nitu ME. Acute respiratory failure in children. Pediatr Ann. 2018;47(7):e268-e273. Review.

[2] ² Bertoni M, Telias I, Urner M, Long M, Del Sorbo L, Fan E, et al. A novel non-invasive method to detect excessively high respiratory effort and dynamic transpulmonary driving pressure during mechanical ventilation. Crit Care. 2019;23(1):346.

[3] ³ Marongiu I, Slobod D, Leali M, Spinelli E, Mauri T. Clinical and experimental evidence for patient self-inflicted lung injury (P-SILI) and bedside monitoring. J Clin Med. 2024;13(14):4018. Review.

[4] ⁴ Goligher EC, Dres M, Patel BK, Sahetya SK, Beitler JR, Telias I, et al. Lung- and diaphragm-protective ventilation. Am J Respir Crit Care Med. 2020;202(7):950-61.

[5] ⁵ Vedrenne-Cloquet M, Ito Y, Hotz J, Klein MJ, Herrera M, Chang D, et al. Phenotypes based on respiratory drive and effort to identify the risk factors when P0.1 fails to estimate ΔPES in ventilated children. Crit Care. 2024;28(1):325.