Patient Self-Inflicted Lung Injury

Patient self-inflicted lung injury (P-SILI) is a controversial, emerging concept, whereby intense inspiratory efforts by spontaneously breathing patients – whether assisted or unassisted – may exacerbate lung injury.

P-SILI can occur in intubated patients, patients on NIV, and patients without any ventilatory support.

What causes P-SILI? Unclear:

1. Swings in transpulmonary pressure
2. Abnormal increases in transvascular pressure
3. Intra-tidal gas shifts between different West lung zones
4. Diaphragm injury
5. Increased lung inflammation ("biotrauma")

P-SILI can be increased in vigorous spontaneous breathing efforts, increased severity of lung disease.