The concept of “baby lung”
- 3.6k Downloads
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).
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.
From a physiological perspective the “baby lung” helps to understand ventilator-induced lung injury. In this context, what appears dangerous is not the VT/kg ratio but instead the VT/”baby lung” ratio. The practical message is straightforward: the smaller the “baby lung,” the greater is the potential for unsafe mechanical ventilation.
KeywordsAcute respiratory distress syndrome Baby lung Baro-/volutrauma Mechanical ventilation Respiratory system compliance Ventilator-induced lung injury
We cannot list individually, but we are deeply indebted to the hundreds of incredible persons who have worked, contributed, and discussed with us over the past 30 years. Without them we could not have reached any result, great or small. Intensive care is founded not only on a “great idea” but on near-paranoid attention to detail and understanding of the minute-by-minute changes in patients’ physiology.
- 2.Gattinoni L, Pesenti A (1987) ARDS: the non-homogeneous lung; facts and hypothesis. Intensive Crit Care Dig 6:1–4Google Scholar
- 35.Gattinoni L, Pelosi P, Valenza F, Mascheroni D (1994) Patient positioning in acute respiratory failure. In: Tobin MJ (ed) Principle and practice of mechanical ventilation. McGraw-Hill, New York, pp 1067–1076Google Scholar
- 50.Weibel ER (1986) Functional morphology of lung parenchyma. In: American Physiological Society (ed) Handbook of physiology a critical, comprehensive presentation of physiological knowledge and concepts. Waverly, Baltimore, pp 89–111Google Scholar
- 51.Wilson TA (1986) Solid mechanics. In: American Physiological Society (ed) Handbook of physiology a critical, comprehensive presentation of physiological knowledge and concepts. Waverly, Baltimore, pp 35–39Google Scholar
- 61.Haseneen NA, Vaday GG, Zucker S, Foda HD (2003) Mechanical stretch induces MMP-2 release and activation in lung endothelium: role of EMMPRIN Am J Physiol Lung Cell Mol Physiol 284:L541–L547Google Scholar
- 67.Weibel ER (1984) The pathway for oxygen structure and function in the mammalian respiratory system. Harvard University Press, CambridgeGoogle Scholar