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Translating Basic Research in Clinical Practice |

Biotrauma and Ventilator Induced Lung Injury: Clinical implications

G.F. Curley, MB, PhD; J.G. Laffey, MD, MA; H. Zhang, MD, PhD; A.S. Slutsky, MD
Author and Funding Information

Conflict of interest statements: Dr. Slutsky reports receiving consulting fees from Baxter, Maquet Medical, and Xenios-Novalung. Drs Curley, Zhang and Laffey report no potential conflicts of interest exist with any companies/organizations whose products or services may be discussed in this article.

Funding Information: GFC, JG, HZ and ASS are supported by the Canadian Institute for Health Research. GC is also supported by a Government of Ontario, Ministry of Research and Innovation, Early Researcher Award and Clinician Scientist Transition Award from the University of Toronto Department of Anesthesia. JL is also supported by Physician Services Incorporated and by the University of Toronto Department of Anesthesia.

1Department of Anesthesia, Keenan Research Centre for Biomedical Science of St Michael’s Hospital, Toronto, Ontario, Canada

2Department of Medicine, St Michael’s Hospital, and the Critical Illness and Injury Research Centre, Keenan Research Centre for Biomedical Science of St Michael’s Hospital, Toronto, Ontario, Canada, M5B 1W8

3Department of Anesthesia, Keenan Research Centre for Biomedical Science of St Michael’s Hospital, Toronto, Ontario, Canada

4Physiology, University of Toronto

5Interdepartmental Division of Critical Care Medicine, University of Toronto

Address for correspondence: A. S. Slutsky, Keenan Research Centre for Biomedical Science of St Michael’s Hospital, 30 Bond Street, Toronto, Ontario, Canada, M5B 1W8.


Copyright 2016, . All Rights Reserved.


Chest. 2016. doi:10.1016/j.chest.2016.07.019
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Abstract

The pathophysiological mechanisms by which mechanical ventilation can contribute to lung injury – termed ventilator induced lung injury (VILI) – is increasingly well understood. “Biotrauma” describes release of mediators by injurious ventilatory strategies, which can lead to lung and distal organ injury. Insights from preclinical models demonstrating that traditional high tidal volumes drove the inflammatory response helped lead to clinical trials demonstrating lower mortality in patients ventilated with a lower tidal volume strategy. Other approaches that minimize VILI, such as higher PEEP, prone positioning and neuromuscular blockade have each been demonstrated to decrease indices of activation of the inflammatory response. This review examines the evolution of our understanding of the mechanisms underlying VILI, particularly with regard to biotrauma. We will assess evidence that ventilatory and other ‘adjunctive’ strategies that decrease biotrauma offer great potential to minimize the adverse consequences of VILI, and to improve the outcomes of patients with respiratory failure.


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