The Role of Cytokines during the Pathogenesis of Ventilator-Associated and Ventilator-Induced Lung Injury

John A. Belperio; Michael P. Keane; Joseph P. Lynch; Robert M. Strieter

doi:10.1055/s-2006-948289

Seminars in Respiratory and Critical Care Medicine, Inhaltsverzeichnis

Semin Respir Crit Care Med 2006; 27(4): 350-364
DOI: 10.1055/s-2006-948289

The Role of Cytokines during the Pathogenesis of Ventilator-Associated and Ventilator-Induced Lung Injury

John A. Belperio¹ , Michael P. Keane¹ , Joseph P. Lynch¹ III , Robert M. Strieter¹ ^, ² ^, ³

¹Department of Medicine, Division of Pulmonary and Critical Care Medicine at The David Geffen School of Medicine at UCLA, Los Angeles, California
²Department of Pediatrics at The David Geffen School of Medicine at UCLA, Los Angeles, California
³Department of Pathology and Laboratory Medicine at The David Geffen School of Medicine at UCLA, Los Angeles, California

Abstract

ABSTRACT

Mortality rates from acute lung injury (ALI)/acute respiratory distress syndrome (ARDS) range from 30 to 65%. Although mechanical ventilation (MV) may delay mortality in critically ill patients with ALI/ARDS, it may also cause a lung injury that further promotes and perpetuates ALI/ARDS and multiorgan dysfunction syndrome (MODS). Recent studies have demonstrated that lung protective strategies of MV, as compared with the injurious strategy of conventional MV (CMV) can reduce absolute mortality rates during ALI/ARDS. The protective strategies limit tidal volumes and peak/plateau pressures while maximizing positive end-expiratory pressure. The injury to the lung by CMV is characterized histologically by edema, leukocyte extravasation, and endothelial and epithelial damage. Both human and animal studies suggest that alveolar cell deformation from CMV leads to the release of cytokines/chemokines which orchestrate the extravasation, activation, and recruitment of leukocytes, causing ventilator-associated lung injury (VALI) and ventilator-induced lung injury (VILI). Moreover, VALI/VILI can perpetuate the chronic inflammatory response during ALI/ARDS and MODS. This article explores the role of cytokines/chemokines during the pathogenesis of VALI/VILI.

KEYWORDS

Cytokines - chemokines - leukocytes - ventilator - lung

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Referenzen

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John A BelperioM.D.

Division of Pulmonary and Critical Care Medicine, The David Geffen School of Medicine at UCLA

900 Veteran Ave., 14-154 Warren Hall, Box 711922, Los Angeles, CA 90095-1786

eMail: jbelperio@mednet.ucla.edu