title: Mechanical ventilation-associated lung fibrosis in acute respiratory distress syndrome: a significant contributor to poor outcome.
abstract: One of the most challenging problems in critical care medicine is the management of patients with the acute respiratory distress syndrome. Increasing evidence from experimental and clinical studies suggests that mechanical ventilation, which is necessary for life support in patients with acute respiratory distress syndrome, can cause lung fibrosis, which may significantly contribute to morbidity and mortality. The role of mechanical stress as an inciting factor for lung fibrosis versus its role in lung homeostasis and the restoration of normal pulmonary parenchymal architecture is poorly understood. In this review, the authors explore recent advances in the field of pulmonary fibrosis in the context of acute respiratory distress syndrome, concentrating on its relevance to the practice of mechanical ventilation, as commonly applied by anesthetists and intensivists. The authors focus the discussion on the thesis that mechanical ventilation-or more specifically, that ventilator-induced lung injury-may be a major contributor to lung fibrosis. The authors critically appraise possible mechanisms underlying the mechanical stress-induced lung fibrosis and highlight potential therapeutic strategies to mitigate this fibrosis.
authors.affiliation: From the Keenan Research Centre in Biomedical Science, St. Michael's Hospital, Toronto, Ontario, Canada (N.E.C.-B., J.G.L., J.V., H.Z., A.S.S.); CIBER de Enfermedades Respiratorias, Instituto de Salud Carlos III, Madrid, Spain (N.E.C.-B., J.V.); Multidisciplinary Organ Dysfunction Evaluation Research Network, Research Unit, Hospital Universitario Dr. Negrin, Las Palmas de Gran Canaria, Spain (N.E.C.-B., J.V.); Departments of Anesthesia and Physiology, University of Toronto, Toronto, Ontario, Canada (J.G.L., H.Z.); Department of Medicine, Unit of Anesthesiology and Intensive Care, Medical School, University of Padua, Azienda Ospedaliera di Padova, Padua, Italy (M.P.); Department of Anesthesiology and Intensive Care Therapy, University Hospital Carl Gustav Carus, Dresden University of Technology, Dresden, Germany (P.M.S.); and Interdepartmental Division of Critical Care Medicine, Department of Medicine, University of Toronto, Toronto, Ontario, Canada (H.Z., A.S.S.).
authors.forename: Nuria E
authors.initials: NE
authors.lastname: Cabrera-Benitez
authors.forename: John G
authors.initials: JG
authors.lastname: Laffey
authors.forename: Matteo
authors.initials: M
authors.lastname: Parotto
authors.forename: Peter M
authors.initials: PM
authors.lastname: Spieth
authors.forename: Jesús
authors.initials: J
authors.lastname: Villar
authors.forename: Haibo
authors.initials: H
authors.lastname: Zhang
authors.forename: Arthur S
authors.initials: AS
authors.lastname: Slutsky
mesh_terms: D006801:Humans; D008168:Lung / Q000473:pathology; D011658:Pulmonary Fibrosis / Q000209:etiology* / Q000473:pathology / Q000628:therapy; D012121:Respiration, Artificial / Q000009:adverse effects*; D012128:Respiratory Distress Syndrome / Q000150:complications* / Q000628:therapy; D015398:Signal Transduction / Q000502:physiology; D055397:Ventilator-Induced Lung Injury / Q000209:etiology* / Q000378:metabolism / Q000473:pathology / Q000503:physiopathology / Q000628:therapy
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