What have we learned from animal models of ventilator-induced lung injury?

Excerpt

Despite its obvious benefits, mechanical ventilation can inflict pulmonary structural damage [1] and destabilize hemodynamics [2]. Deleterious effects of mechanical ventilation—collectively known as ventilator-induced lung injury (VILI)—include inflammatory infiltration and vascular permeability, hyaline membrane formation, and pulmonary edema [3]. Interactive mechanical forces prompt biophysical, biochemical, and biomolecular alterations that ultimately lead to VILI [4]. Repeated non-physiological stretching of lung tissue can release inflammatory mediators, alter gene expression, and either upregulate or downregulate synthesis of several extracellular matrix proteins [5]. Therefore, understanding the physiological and biological consequences of mechanical ventilation and becoming familiar with logical clinical strategies intended to prevent and minimize lung damage are important clinical goals. These cannot be studied directly at the bedside for obvious ethical and logistical reasons. Yet, over the past two decades, the experimental laboratory has provided the needed guidance to develop approaches and equipment modifications essential to VILI prevention. …