Abstract
The innate immune network is responsible for coordinating the initial defense against potentially noxious stimuli. This complex system includes anatomical, physical and chemical barriers, effector cells and circulating molecules that direct component and system interactions. Besides the direct effects of breaching pulmonary protective barriers, cyclic stretch generated during mechanical ventilation (MV) has been implicated in the modulation of the innate immunity. Evidence from recent human trials suggests that controlling MV-forces may significantly impact outcome in acute respiratory distress syndrome. In this paper, we explore the pertinent evidence implicating biotrauma caused by cyclic MV and its effect on innate immune responses.
Highlights
The natural or innate immune system is present in some form in most living organisms and consists of mechanisms for defending the host against foreign invaders and for healing injured tissues
Apart from the direct effects of breaching pulmonary protective barriers, cyclic stretch generated during mechanical ventilation has been implicated in the modulation of the innate immune system
Two other important factors are worthy of mention in this study: systemic LPS was given in a modest dose (5 mg/kg) and did not result in overt acute lung injury (ALI) before initiation of the ventilation protocol; and the mechanical ventilation protocol used levels of Vt that did not lead to disruption of the epithelial cell membrane, as demonstrated by preservation of barrier function and absence of histologic changes consistent with structural disruption
Summary
The natural or innate immune system is present in some form in most living organisms and consists of mechanisms for defending the host against foreign invaders and for healing injured tissues. Two other important factors are worthy of mention in this study: systemic LPS was given in a modest dose (5 mg/kg) and did not result in overt ALI before initiation of the ventilation protocol; and the mechanical ventilation protocol used levels of Vt that did not lead to disruption of the epithelial cell membrane, as demonstrated by preservation of barrier function and absence of histologic changes consistent with structural disruption Based on these findings, the authors postulated that cyclic stretch interacts with innate immune components, which allows leakage of bacterial products, resulting in an enhanced inflammatory response. Pulmonary repair mechanisms are likely to play an active role in determining the ultimate outcome of local injury and ensuing systemic derangement
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