Protective ventilation is the cornerstone of treatment of patients with the acute respiratory distress syndrome (ARDS); however, no studies have yet established the best ventilatory strategy to adopt when patients with acute exacerbation of interstitial lung disease (AE-ILD) are admitted to the intensive care unit. Due to the severe impairment of the respiratory mechanics, the fibrotic lung is at high risk of developing ventilator-induced lung injury, regardless of the lung fibrosis etiology. The purpose of this review is to analyze the effects of mechanical ventilation in AE-ILD and to increase the knowledge on the characteristics of fibrotic lung during artificial ventilation, introducing the concept of "squishy ball lung". The role of positive end-expiratory pressure is discussed, proposing a "lung resting strategy" as opposed to the "open lung approach". The review also discusses the practical management of AE-ILD patients discussing illustrative clinical cases.

中文翻译：

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纤维化肺的“通气支持”和机械性能充当了“湿软的球”。

保护性通风是治疗急性呼吸窘迫综合征（ARDS）患者的基石；但是，尚无任何研究建立将急性间质性肺疾病（AE-ILD）急性加重的患者收治重症监护病房的最佳通气策略。由于呼吸力学的严重损害，无论肺纤维化病因如何，纤维化肺都极有可能发生呼吸机诱发的肺损伤。这篇综述的目的是分析机械通气对AE-ILD的影响，并增加对人工通气中纤维化肺的特征的认识，引入“半球形肺”的概念。讨论了呼气末正压的作用，并提出了“肺部静息策略” 而不是“开放肺法”。该评论还讨论了AE-ILD患者的实际管理，并讨论了示例性临床病例。