Inflammatory mechanisms of lung injury during mechanical ventilation
- Arthur S Slutsky, MD
Arthur S Slutsky, MD
- Professor of Medicine, Surgery and Biomedical Engineering
- University of Toronto School of Medicine
Mechanical ventilation is a life-saving therapy that is the mainstay for treating patients with acute respiratory failure. Since its widespread use was initiated in the early to mid-1950s for the treatment of paralytic poliomyelitis, our understanding of the impact of mechanical ventilation on gas exchange, pulmonary mechanics, and heart-lung interactions has increased tremendously. In addition, the complications of mechanical ventilation have also become more apparent [1,2].
The adverse consequences of mechanical ventilation (other than oxygen toxicity) were thought to be due largely to mechanical factors, such as hemodynamic compromise from decreased venous return and/or barotrauma due to pulmonary overdistention. Subsequent research revealed more subtle types of ventilator-induced lung injury, including diffuse alveolar damage and up-regulation of the inflammatory response; the latter is referred to as biotrauma [3-7]. The concept of biotrauma may help explain why most patients who die with the acute respiratory distress syndrome (ARDS) succumb not to lung failure but to the development of multiple organ dysfunction syndrome (MODS) involving both the lungs and other organs [4,8,9].
Mechanisms of ventilator-induced lung injury, particularly biotrauma, will be reviewed here. General issues related to mechanical ventilation and its use in ARDS are discussed separately. (See "Overview of mechanical ventilation" and "Physiologic and pathophysiologic consequences of mechanical ventilation" and "Mechanical ventilation of adults in acute respiratory distress syndrome".)
TYPES OF VENTILATOR-INDUCED LUNG INJURY (VILI)
Barotrauma refers to gross air leaks (including pneumothorax or pneumomediastinum) that are due to the development of an excessive pressure difference between an alveolus and its adjacent bronchovascular sheath [10-12]. Factors that impact the development of barotrauma include :
●The specific diagnosis (more common with acute respiratory distress syndrome [ARDS]) (see "Secondary spontaneous pneumothorax in adults")
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