Question
What is biotrauma in the context of ARDS, and how does it contribute to multi-organ failure?
Answer
Biotrauma refers to a secondary inflammatory response that arises from mechanical ventilation in patients with acute respiratory distress syndrome (ARDS). Unlike direct, easily identifiable injuries such as pneumothorax, biotrauma occurs at the microscopic level within the alveolar-capillary interface and is not readily apparent on physical exam. It involves the transmission of injurious mechanical forces from the ventilator to the lung tissue, which initiates a localized inflammatory cascade.
This localized inflammation does not remain confined to the lungs. Instead, the release of inflammatory mediators—such as cytokines and other signaling molecules—enters systemic circulation, promoting a widespread immune response that affects distant organs. This systemic spillover can lead to multi-organ dysfunction or failure, significantly increasing morbidity and mortality in ARDS patients. The insidious nature of biotrauma means it requires a combination of clinical insight, imaging, and a nuanced understanding of ventilator management to mitigate the harmful energy transfer and prevent progression to systemic complications.
This Ask the Expert is an edited excerpt from the course, Mechanical Power at a Glance, presented by Keith Lamb, RRT, RRT-ACCS, FAARC, FCCM.
