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The unifying explanation is that the trigger for VILI is an excessive energy/power load, which encompasses all of the mechanical breath parameters.
Although, as mentioned above, there are concerns that oxygenation is not the optimal physiologic parameter by which to set protective mechanical breath parameters, it remains the current clinical standard of care [7, 68].
In addition, the impact of these breath parameters are analyzed as the stress delivered to the lung, and the response of the lung to this applied stress is measured as a strain.
Individual mechanical breath parameters (e.g., Vt or P plat) are not directly correlated with VILI, but rather, any combination of parameters that subject the lung to excessive dynamic strain and energy/power load will cause VILI. 2.
For comparison reasons, breath parameters were defined and controlled in a way that the complete volume was sampled in only one ECoScreen2 chamber.
In view of the potential usefulness of VOCs as markers of lung disease we developed a simple method for their measurement using Proton Transfer Reaction Mass Spectrometry (PTR-MS) and crucially, we standardised the breath collection and studied the effect of different breath parameters such as exhalation flow and breath hold on the levels of the measured gases.
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Changing one single breath parameter, such as lowering Vt or P plat, will not protect the lung unless there is a concomitant reduction in dynamic strain and energy/power load.
After a 7 min familiarization period in the plethysmograph chambers, breathing parameters (breath duration [TTOT], tidal volume [VT], and ventilation [VE] calculated as VT/TTOT) were continuously monitored in apnea-free periods.
We analyzed 100 breaths for tidal breathing parameters, giving more robust estimates than 30 breaths as recommended by the standards [28].
Lung function parameters measured were functional residual capacity (FRC) and ventilation inhomogeneity by multiple breath washout as well as tidal breathing parameters.
We analysed the factors potentially affecting the levels of some VOCs in the breath and standardised a method for their measurement controlling breathing parameters and diet.
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