Don’t bother for a definition, it’s a made up hybrid word, may be a neologisms in the making
The mechanical ventilation literature is jammed with those 2 acronyms VALI (Ventilator Associated Lung Injury) & VILI (Ventilator Induced Lung Injury)
Is there a difference between them ? Are they synonyms ?
If they are the same then why use different terms for the same meaning ? and if they are different, how to differentiate between them ?
is it “You Say Tomato, I say Tomato”
To add to the confusion, some authorities decided to create the term VAE (Ventilator Associated Events), a garbage term that indicates that the condition is worse denoted by the increase in FiO2 or PEEP just to penalize hospitals for it. What they don’t know is sometimes you need to increase PEEP even if FiO2 is 30-40% just to prevent lung injury (whole different lond discussion). Anyway lets go back to VILI-VALI
If you look at the definitions:
VALI: implies lung injury that can happen while the patient is on mechanical ventilation, it could be directly caused by the ventilator (actually our settings, let’s be honest) or just a progression of the disease process that lead the patient to be on the ventilator in the first place.
VILI: is a subset of VALI which implies and incriminates the ventilator (again our settings for the most part) to the progressive worsening of the lung mechanics.
Can we differentiate between both conditions clinically:
maybe but mostly not, the easy one is barotrauma like pneumothorax, pneumomediastinum, but how about all the other terms. volutrauma, atelectrauma, ergotrauma, rheotrauma, biotrauma, ergotrauma ? maybe CT scans, EIT, US can be suggestive but not diagnostic
So far there has been no clinical golden marker or bio-marker that can differentiate or incriminate the ventilator (there are many biomarkers used in research labs and the literature) in the worsening of the patient condition or for gosh sake even VAP (Ventilator Associated Pneumonia) remains a pathological diagnosis as a gold standard despite all the studies, definitions, labs, cultures, etc.
So, lets not fool ourselves and pretend to know what we are talking about when we use one term over the other, or argue which one is correct and which one is incorrect and maybe use the made up term “Indociated” till we really know.
Hopefully, one day we will know
