Acute lung injury: how to stabilize a broken lung

Nieman, Gary F.; Andrews, Penny; Satalin, Joshua; Wilcox, Kailyn; Kollisch-Singule, Michaela; Madden, Maria; Aiash, Hani; Blair, Sarah; Gatto, Louis A.; Habashi, Nader M.

doi:10.1186/s13054-018-2051-8

Cited by 59 publications

(56 citation statements)

References 72 publications

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“…Our TCAV method using the APRV mode has been discussed in detail elsewhere (Habashi, 2005;Jain et al, 2016;Nieman et al, 2018Nieman et al, , 2019Kollisch-Singule et al, 2019). Briefly, TCAV consists of an extended (4-5 s) open valve continuous positive airway pressure (CPAP) phase with a very short (≤0.5 s) release phase.…”

Section: The Tcav Methods To Open and Stabilize The Acutely Injured Lungmentioning

confidence: 99%

“…Although, the phrase resting the lung sounds protective, the lung is not meant to function in a deflated state, and as listed above, such a state is associated with numerous pathologies. If the lung is to be rested, meaning that parenchymal tissue is to be kept from being damaged by mechanical ventilation, the better strategy would be to rest it in the natural inflated state (Nieman et al, 2018).…”

Section: Problems With Resting the Collapsed Lungmentioning

confidence: 99%

“…protective mechanical breath that will allow the lung to heal by eliminating the constraints present when ventilating a heterogeneously injured lung (Nieman et al, 2018).…”

Section: Open Lung Approach (Ola) As a Protective Strategymentioning

confidence: 99%

“…To investigate the relationship between ARDS and VILI, we need to understand the pathology of acute lung injury. Although ARDS is a complex syndrome, it features four wellaccepted central components (Thompson et al, 2017) known as the "pathologic tetrad" (Figure 3) (Nieman et al, 2018). The components of the tetrad include increased pulmonary capillary permeability (Figure 3, Endothelial Leakage), which if unchecked will lead to loss of surfactant function (Figure 3, Surfactant Deactivation) (Lewis et al, 1993).…”

Section: Ards Pathophysiology That Predisposes the Lung To Vili Ards mentioning

confidence: 99%

“…Of course the strategy of "casting" the broken lung open until it heals would be clinically effective only with a ventilation strategy that could perform such a feat (Nieman et al, 2018). Unfortunately, the current OLA strategies have not been shown effective at opening and stabilizing the lung (Bhattacharjee et al, 2018;Cui et al, 2019;Hodgson et al, 2019;Kang et al, 2019;Zheng et al, 2019), and the recent ART trial showed an increase in FIGURE 10 | Left -Subpleural alveoli seen using in vivo microscopy in a rat hemorrhagic shock-induced ARDS model ventilated with volume cycled ventilation (VC; A,B) or airway pressure release ventilation (APRV) using the time controlled adaptive ventilation (TCAV) method (APRV; C,D).…”

Section: Eliminating Constraints Of Ventilating the Acutely Injured Lungmentioning

confidence: 99%

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A Physiologically Informed Strategy to Effectively Open, Stabilize, and Protect the Acutely Injured Lung

et al. 2020

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Acute respiratory distress syndrome (ARDS) causes a heterogeneous lung injury and remains a serious medical problem, with one of the only treatments being supportive care in the form of mechanical ventilation. It is very difficult, however, to mechanically ventilate the heterogeneously damaged lung without causing secondary ventilatorinduced lung injury (VILI). The acutely injured lung becomes time and pressure dependent, meaning that it takes more time and pressure to open the lung, and it recollapses more quickly and at higher pressure. Current protective ventilation strategies, ARDSnet low tidal volume (LVt) and the open lung approach (OLA), have been unsuccessful at further reducing ARDS mortality. We postulate that this is because the LVt strategy is constrained to ventilating a lung with a heterogeneous mix of normal and focalized injured tissue, and the OLA, although designed to fully open and stabilize the lung, is often unsuccessful at doing so. In this review we analyzed the pathophysiology of ARDS that renders the lung susceptible to VILI. We also analyzed the alterations in alveolar and alveolar duct mechanics that occur in the acutely injured lung and discussed how these alterations are a key mechanism driving VILI. Our analysis suggests that the time component of each mechanical breath, at both inspiration and expiration, is critical to normalize alveolar mechanics and protect the lung from VILI. Animal studies and a meta-analysis have suggested that the time-controlled adaptive ventilation (TCAV) method, using the airway pressure release ventilation mode, eliminates the constraints of ventilating a lung with heterogeneous injury, since it is highly effective at opening and stabilizing the time-and pressure-dependent lung. In animal studies it has been shown that by "casting open" the acutely injured lung with TCAV we can (1) reestablish normal expiratory lung volume as assessed by direct observation of subpleural alveoli; (2) return normal parenchymal microanatomical structural support, known as alveolar interdependence and parenchymal tethering, as assessed by morphometric analysis of lung histology; (3) facilitate regeneration of normal surfactant function measured as increases in surfactant proteins A and B; and (4) significantly increase lung compliance, which reduces the pathologic impact of driving pressure and mechanical power at any given tidal volume.

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Section: The Tcav Methods To Open and Stabilize The Acutely Injured Lungmentioning

confidence: 99%

Section: Problems With Resting the Collapsed Lungmentioning

confidence: 99%

“…protective mechanical breath that will allow the lung to heal by eliminating the constraints present when ventilating a heterogeneously injured lung (Nieman et al, 2018).…”

Section: Open Lung Approach (Ola) As a Protective Strategymentioning

confidence: 99%

Section: Ards Pathophysiology That Predisposes the Lung To Vili Ards mentioning

confidence: 99%

Section: Eliminating Constraints Of Ventilating the Acutely Injured Lungmentioning

confidence: 99%

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A Physiologically Informed Strategy to Effectively Open, Stabilize, and Protect the Acutely Injured Lung

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Acute lung injury in patients with COVID‐19 infection

Huang

Wang

et al. 2020

Clinical & Translational Med

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During the 2020 Spring Festival in China, the outbreak of a novel coronavirus, named COVID‐19 by WHO, brought on a worldwide panic. According to the clinical data of infected patients, radiologic evidence of lung edema is common and deserves clinical attention. Lung edema is a manifestation of acute lung injury (ALI) and may progress to hypoxemia and potentially acute respiratory distress syndrome (ARDS). Patients diagnosed with ARDS have poorer prognosis and potentially higher mortality. Although no effective treatment is formally approved for COVID‐19 infection, support of ventilation with oxygen therapy and sometimes mechanical ventilation is often required. Treatment with systemic and/or local glucocorticoids might be helpful to alleviate the pulmonary inflammation and edema, which may decrease the development and/or consequences of ARDS. In this article, we focus on the lung edema and ALI of patients with this widely transmitted COVID‐19 infection in order to provide clinical indications and potential therapeutic targets for clinicians and researchers.

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Functional Extracellular Vesicles for Regenerative Medicine

Kim

Kwon

et al. 2022

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The unique biological characteristics and promising clinical potential of extracellular vesicles (EVs) have galvanized EV applications for regenerative medicine. Recognized as important mediators of intercellular communication, naturally secreted EVs have the potential, as innate biotherapeutics, to promote tissue regeneration. Although EVs have emerged as novel therapeutic agents, challenges related to the clinical transition have led to further functionalization. In recent years, various engineering approaches such as preconditioning, drug loading, and surface modification have been developed to potentiate the therapeutic outcomes of EVs. Also, limitations of natural EVs have been addressed by the development of artificial EVs that offer advantages in terms of production yield and isolation methodologies. In this review, an updated overview of current techniques is provided for the functionalization of natural EVs and recent advances in artificial EVs, particularly in the scope of regenerative medicine.

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Acute lung injury: how to stabilize a broken lung

Cited by 59 publications

References 72 publications

A Physiologically Informed Strategy to Effectively Open, Stabilize, and Protect the Acutely Injured Lung

A Physiologically Informed Strategy to Effectively Open, Stabilize, and Protect the Acutely Injured Lung

Acute lung injury in patients with COVID‐19 infection

Functional Extracellular Vesicles for Regenerative Medicine

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