Extracellular matrix and mechanical ventilation in healthy lungs: back to baro/volotrauma?

Current Opinion in Critical Care
Paolo Pelosi, Daniela Negrini

Abstract

The extracellular matrix plays an important role in the biomechanical behaviour of the lung parenchyma. The matrix is composed of a three-dimensional fibre mesh filled with different macromolecules, including proteoglycans which have important functions in many lung pathophysiological processes, as they regulate tissue hydration, macromolecular structure and function, response to inflammatory agents, and tissue repair and remodelling. The aim of this review is to describe the role of mechanical ventilation on pulmonary extracellular matrix structure and function. Recent experimental and clinical data suggest that in healthy lungs, mechanical ventilation with tidal volume ranging between 7 and 12 ml/kg in the absence of positive end-expiratory pressure may lead to endothelial, extracellular matrix and peripheral airways damage without major inflammatory response. Several mechanisms may explain damage to the lung structure induced by mechanical ventilation: regional overdistension, 'low lung volume' associated with tidal airway closure, and inactivation of surfactant. Tidal volume reduction to 6 ml/kg may be useful during mechanical ventilation of healthy lungs. The study of the extracellular matrix may be useful to better unders...Continue Reading

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Citations

Apr 26, 2014·Critical Care : the Official Journal of the Critical Care Forum·Yuda SutherasanPaolo Pelosi
Nov 27, 2014·Indian Journal of Critical Care Medicine : Peer-reviewed, Official Publication of Indian Society of Critical Care Medicine·Emma JoynesSamia Fayek
May 31, 2012·TheScientificWorldJournal·Manuel García-DelgadoEnrique Fernández-Mondéjar
Jul 27, 2011·Respiratory Physiology & Neurobiology·Joerg KrebsThomas Luecke
Mar 8, 2014·Expert Review of Respiratory Medicine·Yuda SutherasanPaolo Pelosi
Mar 25, 2011·Anesthesiology·Hermann Wrigge, Paolo Pelosi
Jul 23, 2008·ASAIO Journal : a Peer-reviewed Journal of the American Society for Artificial Internal Organs·Niels D NielsenAnders Larsson
Aug 28, 2015·The Open Respiratory Medicine Journal·R Carrasco LozaN Medel Fernández
Mar 15, 2019·Anesthesiology·Nathane S FelixPatricia R M Rocco
Nov 27, 2019·International Journal of Molecular Sciences·Yu-Ling DaiKun-Lun Huang
Aug 12, 2016·Pediatric Critical Care Medicine : a Journal of the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies·Shan L WardHeidi R Flori
Apr 20, 2018·Frontiers in Physiology·Lillian MoraesPatricia R M Rocco

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