{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,29]],"date-time":"2026-05-29T23:03:02Z","timestamp":1780095782728,"version":"3.54.0"},"reference-count":28,"publisher":"Georg Thieme Verlag KG","issue":"12","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Dtsch Med Wochenschr"],"published-print":{"date-parts":[[2026,6]]},"abstract":"<jats:title>Was ist neu?<\/jats:title>\n                  <jats:p>Patient Self-Inflicted Lung Injury (P-SILI) beschreibt ein Konzept, bei welchem sich Patienten in der akuten hypox\u00e4mischen respiratorischen Insuffizienz (AHRF) durch einen hohen Atemantrieb und tiefe Atemz\u00fcge selbst einen Schaden zuf\u00fchren und das Lungenversagen perpetuieren k\u00f6nnen. Die von der Spontanatmung abh\u00e4ngige Lungensch\u00e4digung wird wahrscheinlich durch 4 Mechanismen vermittelt: 1. ein erh\u00f6hter mechanischer Stress, 2. eine heterogene Ventilation mit Pendelluft, 3. ein gesteigerter pulmonaler Blutfluss mit mikrovaskul\u00e4ren Verletzungen sowie 4. eine Patient-Ventilator-Asynchronit\u00e4t (PVA) im Falle einer nicht-invasive Ventilation (NIV) zur Unterst\u00fctzung der Spontanatmung. Alle genannten Vorg\u00e4nge sind eng mit einem gesteigerten Atemantrieb verbunden, welcher sich aus der Pathophysiologie der zugrundeliegenden Lungensch\u00e4digung, insbesondere dem Plasmaeintritt in die Alveolen, erkl\u00e4rt. Durch klinische Messverfahren, wie z.B. der \u00d6sophagusdruckbestimmung, ist ein Monitoring der Atemarbeit und des neuronalen respiratorischen Antriebs m\u00f6glich. Jedoch sind die Messverfahren zum Teil invasiv, in Teilen nicht vollst\u00e4ndig validiert, zeit- und materialaufwendig, kostenintensiv und mitunter durch einen mangelnden Patientenkomfort gekennzeichnet.<\/jats:p>\n                  <jats:p>In der Behandlung des akuten Atemversagens (Acute Respiratory Distress Syndrome (ARDS) und AHRF) muss ein P-SILI zwingend vermieden werden. Neuere Daten zeigen, dass ein sp\u00e4tes NIV-Versagen mit nachfolgender Intubation mit den h\u00f6chsten Mortalit\u00e4tsraten assoziiert ist. Somit ergibt sich eine patientenindividuelle Einzelfallentscheidung \u00fcber die zu bevorzugende Beatmungsform, welche regelm\u00e4\u00dfig auch vor dem Hintergrund eines potenziell m\u00f6glichen P-SILI sowie eines beatmungsassoziierten Lungenschadens kritisch reevaluiert werden muss. NIV und High-Flow-Sauerstofftherapie (HFNC), Pharmakotherapie sowie die Bauchlage unter Spontanatmung haben Grenzen, die 24\/7 neu beurteilt werden m\u00fcssen. Bislang fehlt die Evidenz gro\u00dfer klinischer Studien bez\u00fcglich ihres Einflusses auf die Vermeidung und Behandlung eines P-SILI und des richtigen Zeitpunktes einer Intubation.<\/jats:p>\n                  <jats:p>Als therapeutische M\u00f6glichkeiten eines P-SILI kommen nicht-invasive Beatmungsformen wie die Continuous positive airway pressure (CPAP)\/NIV-Beatmung oder die HFNC sowie die Pharmakotherapie zur Senkung des Atemantriebs in Betracht.<\/jats:p>","DOI":"10.1055\/a-2678-0547","type":"journal-article","created":{"date-parts":[[2026,5,29]],"date-time":"2026-05-29T22:38:29Z","timestamp":1780094309000},"page":"626-632","source":"Crossref","is-referenced-by-count":0,"title":["Patient Self-Inflicted Lung Injury (P-SILI): Pathophysiologie und klinische Implikationen"],"prefix":"10.1055","volume":"151","author":[{"given":"Niklas","family":"Ploenes","sequence":"additional","affiliation":[{"name":"Lungenklinik, Krankenhaus K\u00f6ln-Merheim, Kliniken der Stadt K\u00f6ln gGmbH, Deutschland","place":["K\u00f6ln"]},{"name":"Universit\u00e4t Witten\/Herdecke, Deutschland","place":["Witten"],"department":["Medizinische Fakult\u00e4t"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christian","family":"Karagiannidis","sequence":"additional","affiliation":[{"name":"Lungenklinik, Krankenhaus K\u00f6ln-Merheim, Kliniken der Stadt K\u00f6ln gGmbH, Deutschland","place":["K\u00f6ln"]},{"name":"Universit\u00e4t Witten\/Herdecke, Deutschland","place":["Witten"],"department":["Medizinische Fakult\u00e4t"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stephan Eric","family":"Stra\u00dfmann","sequence":"additional","affiliation":[{"name":"Lungenklinik, Krankenhaus K\u00f6ln-Merheim, Kliniken der Stadt K\u00f6ln gGmbH, Deutschland","place":["K\u00f6ln"]},{"name":"Universit\u00e4t Witten\/Herdecke, Deutschland","place":["Witten"],"department":["Medizinische Fakult\u00e4t"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wolfram","family":"Windisch","sequence":"additional","affiliation":[{"name":"Lungenklinik, Krankenhaus K\u00f6ln-Merheim, Kliniken der Stadt K\u00f6ln gGmbH, Deutschland","place":["K\u00f6ln"]},{"name":"Universit\u00e4t Witten\/Herdecke, Deutschland","place":["Witten"],"department":["Medizinische Fakult\u00e4t"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"194","published-online":{"date-parts":[[2026,5,29]]},"reference":[{"issue":"04","key":"ref1","doi-asserted-by":"publisher","first-page":"438","DOI":"10.1164\/rccm.201605-1081CP","article-title":"Mechanical Ventilation to Minimize Progression of Lung Injury in Acute Respiratory Failure","volume":"195","author":"L Brochard","year":"2017","journal-title":"Am J Respir Crit Care Med"},{"issue":"22","key":"ref2","doi-asserted-by":"publisher","first-page":"2126","DOI":"10.1056\/NEJMra1208707","article-title":"Ventilator-induced lung injury","volume":"369","author":"AS Slutsky","year":"2013","journal-title":"N Engl J Med"},{"issue":"09","key":"ref3","doi-asserted-by":"publisher","first-page":"1014","DOI":"10.23736\/S0375-9393.19.13418-9","article-title":"Patient self-inflicted lung injury: implications for acute hypoxemic respiratory failure and ARDS patients on non-invasive support","volume":"85","author":"DL Grieco","year":"2019","journal-title":"Minerva Anestesiol"},{"issue":"07","key":"ref4","doi-asserted-by":"publisher","first-page":"727","DOI":"10.1007\/s00134-023-07050-7","article-title":"ESICM guidelines on acute respiratory distress syndrome: definition, phenotyping and respiratory support strategies","volume":"49","author":"G Grasselli","year":"2023","journal-title":"Intensive Care Med"},{"issue":"04","key":"ref5","doi-asserted-by":"publisher","first-page":"606","DOI":"10.1007\/s00134-020-05942-6","article-title":"Respiratory drive in the acute respiratory distress syndrome: pathophysiology, monitoring, and therapeutic interventions","volume":"46","author":"E Spinelli","year":"2020","journal-title":"Intensive Care Med"},{"issue":"05","key":"ref6","doi-asserted-by":"crossref","first-page":"1578","DOI":"10.1097\/CCM.0b013e3182451c40","article-title":"Spontaneous breathing during lung-protective ventilation in an experimental acute lung injury model: high transpulmonary pressure associated with strong spontaneous breathing effort may worsen lung injury","volume":"40","author":"T Yoshida","year":"2012","journal-title":"Crit Care Med"},{"issue":"01","key":"ref7","doi-asserted-by":"crossref","first-page":"142","DOI":"10.1186\/s13054-016-1290-9","article-title":"Do spontaneous and mechanical breathing have similar effects on average transpulmonary and alveolar pressure? 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