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Surfactant Depletion Combined with Injurious Ventilation Results in a Reproducible Model of the Acute Respiratory Distress Syndrome ARDS
Published on: April 7, 2021
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Emerging concepts in ventilation-induced lung injury
Purnema Madahar1,2,3, Jeremy R Beitler1,2,3
1Center for Acute Respiratory Failure, Columbia University College of Physicians and Surgeons, New York City, NY, USA.
F1000Research
|April 10, 2020
Summary
Mechanical stress during ventilation causes lung injury, not just from positive pressure but also patient effort. Recognizing and preventing this injury is key to reducing mortality in acute respiratory distress syndrome.
Area of Science:
- Pulmonary Medicine
- Critical Care Medicine
- Biomedical Engineering
Background:
- Ventilation-induced lung injury (VILI) arises from mechanical stress and strain during breathing.
- Traditionally, VILI was linked to positive pressure ventilation, but patient effort and interactions also contribute.
- Regional mechanical differences within the lungs are increasingly recognized as critical in VILI progression.
Purpose of the Study:
- To review the mechanisms and clinical implications of ventilation-induced lung injury.
- To highlight the role of both global and regional lung mechanics in VILI.
- To emphasize the importance of preventing VILI in at-risk patients.
Main Methods:
- Review of existing literature on mechanical ventilation and lung injury.
- Analysis of the biophysical forces involved in VILI.
- Discussion of clinical presentation, diagnosis, and management strategies.
Main Results:
- Injurious forces in VILI can originate from mechanical ventilation and patient-ventilator interactions.
- Lung injury is exacerbated by regional mechanical heterogeneity.
- VILI contributes to worsening lung injury, systemic inflammation, and organ failure.
Conclusions:
- Preventing ventilation-induced lung injury is the most effective strategy to reduce morbidity and mortality.
- Early recognition and intervention are crucial, despite diagnostic challenges.
- VILI prevention benefits patients with acute respiratory distress syndrome and potentially others.
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