Ventilator-Induced Lung Injury (VILI) in Acute Respiratory Distress Syndrome (ARDS): Volutrauma and Molecular Effects



R Carrasco Loza*, 1, 2, G Villamizar Rodríguez 2, N Medel Fernández 1, 2
1 Laboratorio de Investigación Biomédica, Hospital del Salvador, Facultad de Medicina, Universidad de Chile, Santiago, Chile
2 Unidad de Cuidados Intensivos, Clínica Dávila, Santiago, Chile


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© Carrasco Loza et al.; Licensee Bentham Open.

open-access license: This is an open access article licensed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted, non-commercial use, distribution and reproduction in any medium, provided the work is properly cited.

* Address correspondence to this author at the Laboratorio de Investigación Biomédica, Hospital del Salvador, Facultad de Medicina, Universidad de Chile, Avenida Salvador 364, Providencia, Santiago, Chile; E-mail: rcarrascoloza@gmail.com


Abstract

Acute Respiratory Distress Syndrome (ARDS) is a clinical condition secondary to a variety of insults leading to a severe acute respiratory failure and high mortality in critically ill patients. Patients with ARDS generally require mechanical ventilation, which is another important factor that may increase the ALI (acute lung injury) by a series of pathophysiological mechanisms, whose common element is the initial volutrauma in the alveolar units, and forming part of an entity known clinically as ventilator-induced lung injury (VILI).

Injured lungs can be partially protected by optimal settings and ventilation modes, using low tidal volume (VT) values and high positive-end expiratory pressure (PEEP). The benefits in ARDS outcomes caused by these interventions have been confirmed by several prospective randomized controlled trials (RCTs) and are attributed to reduction in volutrauma.

The purpose of this article is to present an approach to VILI pathophysiology focused on the effects of volutrauma that lead to lung injury and the ‘mechanotransduction’ mechanism. A more complete understanding about the molecular effects that physical forces could have, is essential for a better assessment of existing strategies as well as the development of new therapeutic strategies to reduce the damage resulting from VILI, and thereby contribute to reducing mortality in ARDS.

Keywords: Mechanotransduction, positive-end expiratory pressure, tidal volume, VILI, volutrauma.