Overview of ventilator-induced lung injury mechanisms.
OBJECTIVE
Mechanical ventilation is the main supportive therapy for patients with acute respiratory distress syndrome. As with any therapy, mechanical ventilation has side effects and may induce lung injury. This review will focus on stretch-dependent activation of alveolar epithelial and endothelial cells and polymorphonuclear leukocytes, and apoptosis/necrosis balance.


RESULTS
The past year has seen important research in the area of mechanotransduction and lung native immunity, suggesting further mechanisms of lung inflammation and injury in ventilator-induced lung injury. Research in the past year has also stressed the importance of inflammatory response by alveolar cells and role of polymorphonuclear leukocytes in stretch-induced lung injury and has suggested a role for apoptosis in the maintenance of the alveolar epithelium.


CONCLUSIONS
The proportion of patients receiving protective ventilatory strategies remains modest. If efforts to minimize the iatrogenic consequences of mechanical ventilation are to succeed, there must be a greater understanding of the signal transduction mechanisms and the development of potential pharmacologic targets to modulate the molecular and cellular effects of lung stretch.
Lionetti
Vincenzo
V
Laboratorio di Fisiologia e Biologia Molecolare, Classe di Scienze Sperimentali, Settore di Scienze Mediche, Pisa, Italy.
Recchia
Fabio A
FA
Ranieri
V Marco
VM
D000818:Animals; D004195:Disease Models, Animal; D004730:Endothelium, Vascular / Q000293:injuries / Q000503:physiopathology; D006801:Humans; D007249:Inflammation / Q000209:etiology / Q000503:physiopathology; D008168:Lung / Q000378:metabolism / Q000473:pathology; D055370:Lung Injury; D009336:Necrosis / Q000209:etiology / Q000503:physiopathology; D009504:Neutrophils / Q000378:metabolism; D012121:Respiration, Artificial / Q000009:adverse effects*; D012128:Respiratory Distress Syndrome / Q000209:etiology*; D020545:Respiratory Mucosa / Q000293:injuries / Q000503:physiopathology; D013314:Stress, Mechanical; D012122:Ventilators, Mechanical / Q000009:adverse effects*