Abstract
Mechanical injury due to artificial ventilation has been thought to play a role in lung injury for over 250 years (1). However, only recently has it become apparent that this injury is likely not confined to the lung alone, but it may contribute to the development of multi-system organ failure (MSOF) in patients with acute respiratory distress syndrome (ARDS) (2). The major cause of death in patients with ARDS is multiple organ failure, not hypoxia (3). There is little doubt that mechanical ventilation can physically disrupt the lung (4, 5). However, in addition to structural damage, it has been postulated that mechanical ventilation can also induce changes in the activation and recruitment of inflammatory cells, and stimulate the production of a number of inflammatory mediators (2). One theory, is that by altering both the pattern and magnitude of stretch, mechanical ventilation may lead to alterations in gene expression and/or cellular metabolism, ultimately leading to the development of an overwhelming generalized inflammatory response that may eventually lead to MSOF and/or death. This mechanism of injury has been termed biotrauma (2, 6).
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dos Santos, C.C., Liu, M., Slutsky, A.S. (2001). Biotrauma: Signal Transduction and Gene Expression in the Lung. In: Wong, H.R., Shanley, T.P. (eds) Molecular Biology of Acute Lung Injury. Molecular and Cellular Biology of Critical Care Medicine, vol 1. Springer, Boston, MA. https://doi.org/10.1007/978-1-4615-1427-5_19
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