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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Non-invasive mechanical ventilation &#40;NIV&#41; has revolutionized the treatment of patients with acute&#44; chronic&#44; and chronic exacerbated respiratory failure&#46; In the NIV context&#44; bi-level pressure ventilation stands out clearly above other ventilatory modalities such as volume-controlled ventilation or less popular systems such as synchronized intermittent mandatory ventilation&#46;<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">1</span></a> In NIV&#44; the end-expiratory pressure setting is chosen mainly to increase functional residual capacity&#44; improve lung compliance&#44; improve alveolar recruitment&#44; and to counterbalance auto-positive end expiratory pressure &#40;auto-PEEP&#41;&#46; Other important benefits include the positive effects on hemodynamics and the prevention of rebreathing&#46; Inspiratory pressure levels&#44; on the other hand&#44; are aimed at relieving the mechanical burden of fatigued inspiratory muscles&#44; permitting them to rest by taking charge of the patient&#39;s ventilation&#46;<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">2</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">Different ventilatory strategies have been described in the past that define the rational use of NIV in certain clinical scenarios&#46; For example&#44; &#8220;lung-protective ventilation&#8221; alerts physicians to the risk of using high volumes and pressures in lungs with areas of variable compliance&#44; as occurs in respiratory distress&#46; This allows us to prevent such phenomena as atelectrauma and volutrauma&#46;<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">3</span></a> &#8220;High intensity ventilation&#8221;&#44; in contrast&#44; has been defined as an appropriate ventilation strategy in patients with chronic obstructive pulmonary disease &#40;COPD&#41; who are hypercapnic when stable&#46;<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">4</span></a> This ventilatory strategy has been shown to decrease mortality when PaCO2 is normalized or at least reduced by 20&#37;&#44; and is well tolerated by patients&#46;<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">5</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">A paradoxical situation occurs in the case of patients with COPD exacerbation and severe air trapping&#46; These patients typically show signs of hyperinflation&#44; with diaphragmatic flattening&#44; rib horizontalization&#44; increased retrosternal air&#44; and finally auto-PEEP&#44; that causes early airway occlusion&#46; Extra air is the only thing that the lungs of these patients do not need&#44; and it is vital to initiate strategies to facilitate lung emptying&#46; COPD patients naturally learn to prolong their expiration and to breathe through pursed lips to increase pressure in the mouth&#44; thus reducing the pernicious effects of auto-PEEP&#46; The main aim&#44; then&#44; of NIV in patients such as these must be to promote lung emptying rather than ventilation of the lung in the strict sense&#46; Air can only be introduced into a lung that has been previously emptied&#46; Regulating positive expiratory pressure from the ventilator to counter-balance the patient&#39;s auto-PEEP is the basic ventilatory strategy in patients with COPD and air trapping&#46; This ventilatory paradox&#44; the aim of which is to improve the expulsion of air from the lung&#44; rather than to introduce a tidal volume into the lung &#40;normally the essence of ventilation&#41;&#44; should be seen as lung emptying ventilation&#46; Lung emptying improves alveolar ventilation experienced by the patient&#44; and in our opinion&#44; it is time that this ventilatory strategy had its own name&#58; &#8220;alveolar emptying ventilation&#8221;&#46;</p></span>"
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Letter to the Editor
Alveolar Emptying in Mechanical Ventilation
Ventilación de vaciamiento pulmonar
José Manuel Carratalá Peralesa, Salvador Díaz Lobatob,
Corresponding author
sdiazlobato@gmail.com

Corresponding author.
a Unidad de Corta Estancia, Hospital General de Alicante, Alicante, Spain
b Servicio de Neumología, Hospital Universitario Ramón y Cajal, Madrid, Spain
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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Non-invasive mechanical ventilation &#40;NIV&#41; has revolutionized the treatment of patients with acute&#44; chronic&#44; and chronic exacerbated respiratory failure&#46; In the NIV context&#44; bi-level pressure ventilation stands out clearly above other ventilatory modalities such as volume-controlled ventilation or less popular systems such as synchronized intermittent mandatory ventilation&#46;<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">1</span></a> In NIV&#44; the end-expiratory pressure setting is chosen mainly to increase functional residual capacity&#44; improve lung compliance&#44; improve alveolar recruitment&#44; and to counterbalance auto-positive end expiratory pressure &#40;auto-PEEP&#41;&#46; Other important benefits include the positive effects on hemodynamics and the prevention of rebreathing&#46; Inspiratory pressure levels&#44; on the other hand&#44; are aimed at relieving the mechanical burden of fatigued inspiratory muscles&#44; permitting them to rest by taking charge of the patient&#39;s ventilation&#46;<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">2</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">Different ventilatory strategies have been described in the past that define the rational use of NIV in certain clinical scenarios&#46; For example&#44; &#8220;lung-protective ventilation&#8221; alerts physicians to the risk of using high volumes and pressures in lungs with areas of variable compliance&#44; as occurs in respiratory distress&#46; This allows us to prevent such phenomena as atelectrauma and volutrauma&#46;<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">3</span></a> &#8220;High intensity ventilation&#8221;&#44; in contrast&#44; has been defined as an appropriate ventilation strategy in patients with chronic obstructive pulmonary disease &#40;COPD&#41; who are hypercapnic when stable&#46;<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">4</span></a> This ventilatory strategy has been shown to decrease mortality when PaCO2 is normalized or at least reduced by 20&#37;&#44; and is well tolerated by patients&#46;<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">5</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">A paradoxical situation occurs in the case of patients with COPD exacerbation and severe air trapping&#46; These patients typically show signs of hyperinflation&#44; with diaphragmatic flattening&#44; rib horizontalization&#44; increased retrosternal air&#44; and finally auto-PEEP&#44; that causes early airway occlusion&#46; Extra air is the only thing that the lungs of these patients do not need&#44; and it is vital to initiate strategies to facilitate lung emptying&#46; COPD patients naturally learn to prolong their expiration and to breathe through pursed lips to increase pressure in the mouth&#44; thus reducing the pernicious effects of auto-PEEP&#46; The main aim&#44; then&#44; of NIV in patients such as these must be to promote lung emptying rather than ventilation of the lung in the strict sense&#46; Air can only be introduced into a lung that has been previously emptied&#46; Regulating positive expiratory pressure from the ventilator to counter-balance the patient&#39;s auto-PEEP is the basic ventilatory strategy in patients with COPD and air trapping&#46; This ventilatory paradox&#44; the aim of which is to improve the expulsion of air from the lung&#44; rather than to introduce a tidal volume into the lung &#40;normally the essence of ventilation&#41;&#44; should be seen as lung emptying ventilation&#46; Lung emptying improves alveolar ventilation experienced by the patient&#44; and in our opinion&#44; it is time that this ventilatory strategy had its own name&#58; &#8220;alveolar emptying ventilation&#8221;&#46;</p></span>"
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Article information
ISSN: 15792129
Original language: English
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