The concept of "baby lung"
- PMID: 15812622
- DOI: 10.1007/s00134-005-2627-z
The concept of "baby lung"
Abstract
Background: The "baby lung" concept originated as an offspring of computed tomography examinations which showed in most patients with acute lung injury/acute respiratory distress syndrome that the normally aerated tissue has the dimensions of the lung of a 5- to 6-year-old child (300-500 g aerated tissue).
Discussion: The respiratory system compliance is linearly related to the "baby lung" dimensions, suggesting that the acute respiratory distress syndrome lung is not "stiff" but instead small, with nearly normal intrinsic elasticity. Initially we taught that the "baby lung" is a distinct anatomical structure, in the nondependent lung regions. However, the density redistribution in prone position shows that the "baby lung" is a functional and not an anatomical concept. This provides a rational for "gentle lung treatment" and a background to explain concepts such as baro- and volutrauma.
Conclusions: From a physiological perspective the "baby lung" helps to understand ventilator-induced lung injury. In this context, what appears dangerous is not the V(T)/kg ratio but instead the V(T)/"baby lung" ratio. The practical message is straightforward: the smaller the "baby lung," the greater is the potential for unsafe mechanical ventilation.
Similar articles
-
Lung Recruitability in Severe Acute Respiratory Distress Syndrome Requiring Extracorporeal Membrane Oxygenation.Crit Care Med. 2019 Sep;47(9):1177-1183. doi: 10.1097/CCM.0000000000003837. Crit Care Med. 2019. PMID: 31419216
-
Acute lung injury and the acute respiratory distress syndrome: a clinical review.Lancet. 2007 May 5;369(9572):1553-1564. doi: 10.1016/S0140-6736(07)60604-7. Lancet. 2007. PMID: 17482987 Review.
-
Assessment of electrical impedance tomography to set optimal positive end-expiratory pressure for veno-venous ECMO-treated severe ARDS patients.J Crit Care. 2020 Dec;60:38-44. doi: 10.1016/j.jcrc.2020.06.017. Epub 2020 Jul 8. J Crit Care. 2020. PMID: 32736198
-
Effect of Driving Pressure Change During Extracorporeal Membrane Oxygenation in Adults With Acute Respiratory Distress Syndrome: A Randomized Crossover Physiologic Study.Crit Care Med. 2020 Dec;48(12):1771-1778. doi: 10.1097/CCM.0000000000004637. Crit Care Med. 2020. PMID: 33044283 Clinical Trial.
-
Beyond volutrauma in ARDS: the critical role of lung tissue deformation.Crit Care. 2011 Apr 7;15(2):304. doi: 10.1186/cc10052. Crit Care. 2011. PMID: 21489320 Free PMC article. Review.
Cited by
-
Acute respiratory distress syndrome.Lancet. 2016 Nov 12;388(10058):2416-2430. doi: 10.1016/S0140-6736(16)00578-X. Epub 2016 Apr 28. Lancet. 2016. PMID: 27133972 Free PMC article. Review.
-
High-frequency oscillatory ventilation versus conventional ventilation for acute respiratory distress syndrome.Cochrane Database Syst Rev. 2016 Apr 4;4(4):CD004085. doi: 10.1002/14651858.CD004085.pub4. Cochrane Database Syst Rev. 2016. PMID: 27043185 Free PMC article. Review.
-
"Awake" extracorporeal membrane oxygenation (ECMO): pathophysiology, technical considerations, and clinical pioneering.Crit Care. 2016 Jun 30;20(1):150. doi: 10.1186/s13054-016-1329-y. Crit Care. 2016. PMID: 27357690 Free PMC article. Review.
-
Pre-treatment with dexamethasone attenuates experimental ventilator-induced lung injury.J Bras Pneumol. 2016 May-Jun;42(3):166-73. doi: 10.1590/S1806-37562015000000350. J Bras Pneumol. 2016. PMID: 27383928 Free PMC article.
-
Increasing the inspiratory time and I:E ratio during mechanical ventilation aggravates ventilator-induced lung injury in mice.Crit Care. 2015 Jan 28;19(1):23. doi: 10.1186/s13054-015-0759-2. Crit Care. 2015. PMID: 25888164 Free PMC article.
References
MeSH terms
LinkOut - more resources
Full Text Sources
