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(Chest. 2006;130:1906-1914.)
© 2006 American College of Chest Physicians

Pathogenetic Significance of Biological Markers of Ventilator-Associated Lung Injury in Experimental and Clinical Studies*

James A. Frank, MD; Polly E. Parsons, MD, FCCP and Michael A. Matthay, MD, FCCP

* From the Departments of Medicine (Dr. Frank) and Anesthesia (Dr. Matthay), University of California, San Francisco, San Francisco, CA; and the Department of Medicine, Division of Pulmonary and Critical Care (Dr. Parsons), University of Vermont, Burlington, VT.

Correspondence to: James A. Frank, MD, Division of Pulmonary and Critical Care Medicine, University of California, San Francisco, Director, Medical Intensive Care Unit, San Francisco VA Medical Center, 4150 Clement St, Mail Stop 111D, San Francisco, CA 94121; e-mail: james.frank{at}ucsf.edu

Abstract

For patients with acute lung injury, positive pressure mechanical ventilation is life saving. However, considerable experimental and clinical data have demonstrated that how clinicians set the tidal volume, positive end-expiratory pressure, and plateau airway pressure influences lung injury severity and patient outcomes including mortality. In order to better identify ventilator-associated lung injury (VALI), clinical investigators have sought to measure blood-borne and airspace biological markers of VALI. At the same time, several laboratory-based studies have focused on biological markers of inflammation and organ injury in experimental models in order to clarify the mechanisms of ventilator-induced lung injury (VILI) and VALI. This review summarizes data on biological markers of VALI and VILI from both clinical and experimental studies with an emphasis on markers identified in patients and in the experimental setting. This analysis suggests that measurement of some of these biological markers may be of value in diagnosing VALI and in understanding its pathogenesis.

Key Words: ARDS • critical care • ventilation • ventilator-induced lung injury






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