Mechanical ventilation energy analysis: Recruitment focuses injurious power in the ventilated lung.

Summary

A new energy accounting framework in porcine ARDS shows that rapid, localized recruitment/derecruitment dissipates a small fraction of total energy but at damaging intensity, correlating with injury and recovery. Overdistension and viscoelastic losses were less predictive, reframing ventilator power targets.

Key Findings

• Developed a method to quantify ventilatory energy transport/dissipation and partition into airflow, tissue viscoelasticity, and recruitment/derecruitment (RD).
• Only RD energy tracked with physiologic recovery/injury despite constituting ~2–5% of total dissipation.
• RD is injurious due to high power intensity over small areas; estimated intensity on the order of ~100 W/m (incomplete unit in abstract).

Clinical Implications

Supports strategies minimizing cyclic recruitment (adequate PEEP, open-lung approaches, avoiding derecruitment) and suggests monitoring energy components could reduce VILI risk.

Limitations

• Animal model and 6-hour observation limit direct clinical generalizability
• Specialized instrumentation/analysis may be challenging for bedside translation

Future Directions

Translate energy partitioning to bedside surrogates; test ventilation strategies specifically minimizing RD intensity and validate against VILI outcomes in clinical trials.