Evolutionary patterns and research frontiers in ventilator-induced lung injury: a bibliometric analysis (2000-2024)

Ventilator-induced lung injury (VILI) is a major complication of mechanical ventilation and contributes substantially to morbidity and mortality in critically ill patients. Despite extensive investigations into the pathophysiological mechanisms and preventive strategies of VILI, the global research landscape, collaborative networks, and emerging trends in this field have not been comprehensively characterized. This study aimed to systematically evaluate the development, research hotspots, and future directions of VILI research through bibliometric analysis.

Publications related to VILI published between 2000 and 2024 were retrieved from the Web of Science Core Collection (WoSCC). Bibliometric indicators, including annual publication output, citations, countries, institutions, authors, journals, and keywords, were analyzed. Visualization and network analyses were conducted using Bibliometrix (R package), VOSviewer, and CiteSpace to identify research collaborations, influential contributors, knowledge structures, and emerging research themes.

A total of 4,055 publications were included in the analysis. The annual number of publications (NP) and citations demonstrated a sustained upward trend, reflecting growing scientific interest in VILI. The United States was the leading contributor in terms of publication output, citations, and international collaborations. Harvard University and other major academic institutions played central roles in advancing the field. Highly cited studies primarily focused on lung-protective ventilation strategies, mechanical stress-induced inflammatory responses, and acute respiratory distress syndrome (ARDS). Keyword co-occurrence, burst detection, and thematic analyses revealed that inflammation, oxidative stress, NLRP3 inflammasome activation, epithelial and endothelial barrier dysfunction, mechanotransduction, and precision ventilation strategies have emerged as major research hotspots. Recent studies increasingly focus on molecular mechanisms and translational interventions aimed at reducing ventilator-associated lung damage.

Research on VILI has expanded substantially over the past two decades, with increasing global collaboration and diversification of research themes. Current hotspots have shifted from clinical ventilation strategies toward mechanistic investigations involving inflammatory signaling pathways and cellular injury processes. These findings provide a comprehensive overview of the intellectual structure and developmental trajectory of VILI research and may help guide future basic, translational, and clinical investigations in this field.