Evidence map›Paper›PMID 41160383›Full record

ArticleIntensive care medicine experimental2025

Lung injury promoted by strong inspiratory efforts and breath stacking: impact of ventilation mode.

Yasuhiro Norisue, Sunao Usami, Yukie Ito, Muneyuki Takeuchi, Atsushi Kawamura, Ryuichi Nakayama, Naofumi Bunya, Jun Kataoka, Yusuke Endo, Takaharu Itami and 9 more

Abstract read
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Article in Intensive care medicine experimental, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 2 papers.

0numbers the graph read from it
0cells of the map it votes in
2citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

2 citing papers in PubMed.

  1. Article
  2. Review
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

19 authors.

Yasuhiro NorisueDepartment of Pulmonary and Critical Care Medicine, Tokyo Bay Urayasu Ichikawa Medical Center, Urayasu, Chiba, Japan. norisue.yasuhiro@gmail.com.ORCID http://orcid.org/0000-0002-8748-5404
Sunao UsamiDepartment of Clinical Engineer, Tokyo Bay Urayasu Ichikawa Medical Center, Urayasu, Chiba, Japan.
Yukie ItoDepartment of Intensive Care Medicine, Osaka Women's and Children's Hospital, Osaka, Japan.
Muneyuki TakeuchiDepartment of Critical Care Medicine, National Cerebral and Cardiovascular Center, Osaka, Japan.
Atsushi KawamuraDepartment of Intensive Care Medicine, Osaka Women's and Children's Hospital, Osaka, Japan.
Ryuichi NakayamaDepartment of Intensive Care Medicine, Division of Anesthesiology and Intensive Care Medicine, Jichi Medical University, Tochigi, Japan.
Naofumi BunyaDepartment of Emergency Medicine, Sapporo Medical University School of Medicine, Sapporo, Japan.
Jun KataokaDepartment of Critical Care Medicine, Nerima Hikarigaoka Hospital, Tokyo, Japan.
Yusuke EndoDepartment of Veterinary Medicine, School of Veterinary Medicine, Rakuno Gakuen University, Ebetsu, Japan.
Takaharu ItamiDepartment of Veterinary Medicine, School of Veterinary Medicine, Rakuno Gakuen University, Ebetsu, Japan.
Taku HirokawaDepartment of Veterinary Medicine, School of Veterinary Medicine, Rakuno Gakuen University, Ebetsu, Japan.
Chihiro SugitaDepartment of Veterinary Medicine, School of Veterinary Medicine, Rakuno Gakuen University, Ebetsu, Japan.
Hirotaka TakeshimaDepartment of Intensive Care Medicine, Osaka Women's and Children's Hospital, Osaka, Japan.
Airi TakemotoDepartment of Intensive Care Medicine, Osaka Women's and Children's Hospital, Osaka, Japan.
Miyako KyogokuDepartment of Critical Care Medicine, National Cerebral and Cardiovascular Center, Osaka, Japan.
Junki KoikeDepartment of Diagnostic Pathology, St. Marianna University School of Medicine, Kawasaki, Kanagawa, Japan.
Shigeki FujitaniDepartment of Emergency and Critical Care Medicine, St. Marianna University School of Medicine, Kawasaki, Kanagawa, Japan.
Francesco MojoliDepartment of Anesthesia and Intensive Care, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy.
Taku MiyashoDepartment of Veterinary Medicine, School of Veterinary Medicine, Rakuno Gakuen University, Ebetsu, Japan.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundBreath stacking, particularly double triggering, is a common patient-ventilator asynchrony during strong inspiratory effort. It can cause excessive tidal volumes and high transpulmonary pressures, contributing to ventilator-induced lung injury (VILI). The mode-specific consequences of breath stacking induced by strong inspiratory effort remain unclear.

methodsIn a porcine model of minimal lung injury, 17 animals were randomized to volume-controlled ventilation (VCV, n = 9) or pressure-controlled ventilation (PCV, n = 8). High respiratory drive was induced with continuous CO₂ inhalation, and ventilator settings were dynamically adjusted to maintain a breath stacking ratio of 40-70% of spontaneous efforts. Measurements included airway and transpulmonary pressures, driving pressures, tidal volume, esophageal pressure swings (ΔPes), stress index (SI), respiratory compliance, and histological lung injury. Risk factors for baro/volutrauma were defined by elevated plateau or driving pressures, transpulmonary pressures, or tidal volume >10 mL/kg. Atelectrauma risk was defined by SI < 0.9, negative end-expiratory transpulmonary pressure (PLexp), or vigorous effort (ΔPes > 5 cmH₂O or Pmus > 8 cmH₂O).

resultsVCV animals exhibited higher respiratory rates (44.0 vs. 30.5 breaths/min, p = 0.027), whereas PCV resulted in stronger inspiratory efforts (ΔPes 6.1 vs. 4.2 cmH₂O, p = 0.015). During breath stacking, VCV produced larger tidal volumes and higher plateau pressures, accumulating more baro/volutrauma risk factors (median 4.0 vs. 0.0, p < 0.001). In contrast, PCV animals developed more atelectrauma risk factors (3.0 vs. 1.0, p = 0.004). Histological injury scores were comparable, with a non-significant trend toward greater severity in PCV.

conclusionsBreath stacking under strong inspiratory drive can promote lung injury through distinct mechanisms depending on ventilation mode. VCV was associated with the risk of overdistension, whereas PCV involved vigorous inspiratory effort and potential atelectrauma. Double triggering should be recognized as a clinical warning sign, prompting careful assessment of respiratory drive, inspiratory effort, and ventilator settings.

Indexed as

AtelectraumaBreath stackingPatient–ventilator interactionPorcine modelPressure-controlled ventilationP-SILISpontaneous effortVentilator-induced lung injuryVolume-controlled ventilation

Identifiers

PMID41160383
PMCPMC12572466

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.