Lung Mechanics Over the Century: From Bench to Bedside and Back to Bench

Abstract

Lung physiology research advanced significantly over the last 100 years. Respiratory mechanics applied to animal models of lung disease extended the knowledge of the workings of respiratory system. In human research, a better understanding of respiratory mechanics has contributed to development of mechanical ventilators. In this review, we explore the use of respiratory mechanics in basic science to investigate asthma and chronic obstructive pulmonary disease (COPD). We also discuss the use of lung mechanics in clinical care and its role on the development of modern mechanical ventilators. Additionally, we analyse some bench-developed technologies that are not in widespread use in the present but can become part of the clinical arsenal in the future. Finally, we explore some of the difficult questions that intensive care doctors still face when managing respiratory failure. Bringing back these questions to bench can help to solve them. Interaction between basic and translational science and human subject investigation can be very rewarding, as in the conceptualization of “Lung Protective Ventilation” principles. We expect this interaction to expand further generating new treatments and managing strategies for patients with respiratory disease.

Electropneumatic system for the simulation of the pulmonary viscoelastic effect in a mechanical ventilation scenario

“…An alteration in the viscoelastic characteristics of the lung has been described in animal models when pulmonary fibrosis is induced in them (a condition characterized by an excess in the production of extracellular matrix molecules such as collagen, elastin, and proteoglycans), generating an increase in elastance and a decrease in hysteresivity 22 . In addition to pulmonary fibrosis, other pathologies such as asthma and emphysema have been identified, which are related to significant changes that can be local or diffuse in lung viscoelasticity 24 .…”

Advances in mechanical biomarkers

“…However, external injuries are not the only cases where the mechanics of the respiratory system is compromised. Chronic obstructive pulmonary diseases (COPD) are a group of respiratory conditions that progressively reduce the airflow in patients inhibiting breathing 241 . Recent studies have shown how lung elasticity in COPD can be indirectly measured through image post‐processing of quantitative computed tomography (CT), allowing a better diagnosis of respiratory conditions with this biomarker 86,242 .…”

“…Chronic obstructive pulmonary diseases (COPD) are a group of respiratory conditions that progressively reduce the airflow in patients inhibiting breathing. 241 Recent studies have shown how lung elasticity in COPD can be indirectly measured through image post-processing of quantitative computed tomography (CT), allowing a better diagnosis of respiratory conditions with this biomarker. 86,242 Pulmonary fibrosis is another important condition where the lung parenchyma changes its mechanical properties (Figure 4, respiratory diseases).…”