{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,27]],"date-time":"2026-10-27T23:03:30Z","timestamp":1793142210373,"version":"4.5.0"},"reference-count":30,"publisher":"Oxford University Press (OUP)","issue":"10","license":[{"start":{"date-parts":[[2011,5,1]],"date-time":"2011-05-01T00:00:00Z","timestamp":1304208000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/pages\/standard-publication-reuse-rights"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2011,5,15]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Rationale<\/jats:title>\n                    <jats:p>Unphysiologic strain (the ratio between tidal volume and functional residual capacity) and stress (the transpulmonary pressure) can cause ventilator-induced lung damage.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>To identify a strain\u2013stress threshold (if any) above which ventilator-induced lung damage can occur.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Twenty-nine healthy pigs were mechanically ventilated for 54 hours with a tidal volume producing a strain between 0.45 and 3.30. Ventilator-induced lung damage was defined as net increase in lung weight.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Measurements and Main Results<\/jats:title>\n                    <jats:p>Initial lung weight and functional residual capacity were measured with computed tomography. Final lung weight was measured using a balance. After setting tidal volume, data collection included respiratory system mechanics, gas exchange and hemodynamics (every 6 h); cytokine levels in serum (every 12 h) and bronchoalveolar lavage fluid (end of the experiment); and blood laboratory examination (start and end of the experiment). Two clusters of animals could be clearly identified: animals that increased their lung weight (n = 14) and those that did not (n = 15). Tidal volume was 38 \u00b1 9 ml\/kg in the former and 22 \u00b1 8 ml\/kg in the latter group, corresponding to a strain of 2.16 \u00b1 0.58 and 1.29 \u00b1 0.57 and a stress of 13 \u00b1 5 and 8 \u00b1 3 cm H2O, respectively. Lung weight gain was associated with deterioration in respiratory system mechanics, gas exchange, and hemodynamics, pulmonary and systemic inflammation and multiple organ dysfunction.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>In healthy pigs, ventilator-induced lung damage develops only when a strain greater than 1.5\u20132 is reached or overcome. Because of differences in intrinsic lung properties, caution is warranted in translating these findings to humans.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1164\/rccm.201010-1757oc","type":"journal-article","created":{"date-parts":[[2011,2,4]],"date-time":"2011-02-04T22:37:28Z","timestamp":1296859048000},"page":"1354-1362","source":"Crossref","is-referenced-by-count":305,"title":["Lung Stress and Strain during Mechanical Ventilation: Any Safe Threshold?"],"prefix":"10.1093","volume":"183","author":[{"given":"Alessandro","family":"Protti","sequence":"first","affiliation":[{"name":"Dipartimento di Anestesiologia, Terapia Intensiva e Scienze Dermatologiche, and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Massimo","family":"Cressoni","sequence":"additional","affiliation":[{"name":"Dipartimento di Anestesiologia, Terapia Intensiva e Scienze Dermatologiche, and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alessandro","family":"Santini","sequence":"additional","affiliation":[{"name":"Dipartimento di Anestesiologia, Terapia Intensiva e Scienze Dermatologiche, and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thomas","family":"Langer","sequence":"additional","affiliation":[{"name":"Dipartimento di Anestesiologia, Terapia Intensiva e Scienze Dermatologiche, and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cristina","family":"Mietto","sequence":"additional","affiliation":[{"name":"Dipartimento di Anestesiologia, Terapia Intensiva e Scienze Dermatologiche, and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniela","family":"Febres","sequence":"additional","affiliation":[{"name":"Dipartimento di Anestesiologia, Terapia Intensiva e Scienze Dermatologiche, and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Monica","family":"Chierichetti","sequence":"additional","affiliation":[{"name":"Dipartimento di Anestesiologia, Terapia Intensiva e Scienze Dermatologiche, and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Silvia","family":"Coppola","sequence":"additional","affiliation":[{"name":"Dipartimento di Anestesiologia, Terapia Intensiva e Scienze Dermatologiche, and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Grazia","family":"Conte","sequence":"additional","affiliation":[{"name":"Centro di Ricerche Chirurgiche Precliniche, Universit\u00e0 degli Studi di Milano, Milan, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stefano","family":"Gatti","sequence":"additional","affiliation":[{"name":"Centro di Ricerche Chirurgiche Precliniche, Universit\u00e0 degli Studi di Milano, Milan, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Orazio","family":"Leopardi","sequence":"additional","affiliation":[{"name":"Dipartimento di Anestesiologia, Terapia Intensiva e Scienze Dermatologiche, and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Serge","family":"Masson","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Research, Istituto Mario Negri, Milan, Italy; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Luciano","family":"Lombardi","sequence":"additional","affiliation":[{"name":"Dipartimento di Radiologia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marco","family":"Lazzerini","sequence":"additional","affiliation":[{"name":"Dipartimento di Radiologia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Erica","family":"Rampoldi","sequence":"additional","affiliation":[{"name":"Unit\u00e0 Operativa Laboratorio Centrale, and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paolo","family":"Cadringher","sequence":"additional","affiliation":[{"name":"Dipartimento di Anestesiologia, Terapia Intensiva e Scienze Dermatologiche, and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Luciano","family":"Gattinoni","sequence":"additional","affiliation":[{"name":"Dipartimento di Anestesiologia, Terapia Intensiva e Scienze Dermatologiche, and"},{"name":"Dipartimento di Anestesia, Rianimazione (Intensiva e Subintensiva) e Terapia del Dolore, Fondazione IRCCS Ca' Granda - 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