Objectives Describe the impact of trauma on the respiratory system. Explain the rationale for using lung-protective strategies in the injured patient. Evaluate the role of less conventional modes of mechanical ventilation in trauma. Discuss the influence of common trauma-related conditions on the approach to mechanical ventilation. Physiologic effects of trauma on respiratory system Pulmonary trauma and aggressive resuscitation can lead to edema, bleeding, and resultant inflammation within the alveolar spaces. The response to injury represents a continuum from subclinical elevation in inflammatory markers to acute lung injury (ALI) to acute respiratory distress syndrome (ARDS). The physiological effects of trauma on the respiratory system can be looked at in the context of the lung’s ability to repair and regenerate. The lung is an intricate organ and requires interactions between over 40 different cell lines to affect development or repair. The intricacy of these structural and repair mechanisms can impact how well the pulmonary system can restore itself. It is important to understand the difference between regeneration and lung repair. Normally, the lung tissue only performs low levels of cell regeneration and has the innate ability to activate a rapid cycle of regeneration in response to acute injury. Repair can lead to scar formation, fibrosis, and repopulation of pulmonary segments with epithelium that does not function well.
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