Effect of invasive mechanical ventilation on the diversity of the pulmonary microbiota
Chang Liu1,2, Kang Wu1, Tianyu Sun1
1College of Pulmonary & Critical Care Medicine, 8th Medical Center, Chinese PLA General Hospital, Beijing, China.
Abstract:
Pulmonary microbial diversity may be influenced by biotic or abiotic conditions (e.g., disease, smoking, invasive mechanical ventilation (MV), etc.). Specially, invasive MV may trigger structural and physiological changes in both tissue and microbiota of lung, due to gastric and oral microaspiration, altered body posture, high O2 inhalation-induced O2 toxicity in hypoxemic patients, impaired airway clearance and ventilator-induced lung injury (VILI), which in turn reduce the diversity of the pulmonary microbiota and may ultimately lead to poor prognosis. Furthermore, changes in (local) O2 concentration can reduce the diversity of the pulmonary microbiota by affecting the local immune microenvironment of lung. In conclusion, systematic literature studies have found that invasive MV reduces pulmonary microbiota diversity, and future rational regulation of pulmonary microbiota diversity by existing or novel clinical tools (e.g., lung probiotics, drugs) may improve the prognosis of invasive MV treatment and lead to more effective treatment of lung diseases with precision.
Insights
Invasive mechanical ventilation (MV) significantly reduces pulmonary microbial diversity, potentially worsening patient outcomes. Future strategies may involve regulating this diversity for improved lung disease treatment.
Area of Science:
- Pulmonary microbiology
- Critical care medicine
- Host-microbiome interactions
Background:
- Pulmonary microbial diversity is influenced by various factors, including disease and smoking.
- Invasive mechanical ventilation (MV) can induce significant structural and physiological changes in the lungs.
- These changes may stem from microaspiration, altered posture, oxygen toxicity, and ventilator-induced lung injury (VILI).
Purpose of the Study:
- To investigate the impact of invasive mechanical ventilation on pulmonary microbial diversity.
- To explore the mechanisms by which MV affects lung microbiota.
- To assess the implications of altered microbial diversity for patient prognosis.
Main Methods:
- Systematic literature review of studies examining pulmonary microbiota in the context of invasive MV.
- Analysis of factors contributing to microbiota changes during MV, including O2 concentration and immune microenvironment.
Main Results:
- Invasive mechanical ventilation was found to reduce pulmonary microbial diversity.
- Mechanisms include microaspiration, altered lung physiology, oxygen toxicity, and VILI.
- Changes in local oxygen concentration and immune response further impact microbial diversity.
Conclusions:
- Invasive MV is associated with a significant reduction in pulmonary microbial diversity.
- This reduction may negatively affect prognosis in patients requiring MV.
- Future therapeutic strategies targeting pulmonary microbiota diversity could improve outcomes for lung diseases.
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