Tiny Explosions in the Lungs: The Hidden Risk of Mechanical Ventilation

Mechanical ventilators save lives, but they may also be causing hidden damage.

A groundbreaking study reveals that the repeated collapse and reopening of tiny air sacs in the lungs create intense microscopic stress — akin to “tiny explosions” — that may contribute to life-threatening ventilator-induced lung injuries.

Hidden Dangers of Mechanical Ventilation

A new study from Tulane University suggests that the repeated collapse and reopening of tiny air sacs in the lungs, known as alveoli, may cause microscopic tissue damage during mechanical ventilation. This damage could play a significant role in ventilator-related injuries, which contribute to thousands of deaths each year.

Published today (March 3) in the Proceedings of the National Academy of Sciences (PNAS), the study examines ventilator-induced lung injury, a serious complication that became more widely recognized during the COVID-19 pandemic when ventilator use surged. Mechanical ventilators help patients breathe by pushing oxygen-rich air into their lungs when they are unable to do so effectively on their own.

The Alveolar Cycle and Its Impact

Researchers found that a process called alveolar recruitment and derecruitment — when air sacs repeatedly collapse and reopen — accounts for just 2-5% of the total energy used during ventilation. However, in a model of acute respiratory distress syndrome (ARDS), this small energy dissipation was directly linked to lung injury.

“It’s like a tiny explosion at the delicate lung surface,” said lead author Donald P. Gaver, a biomedical engineering professor at Tulane University School of Science and Engineering. “Though small in magnitude, it creates a power intensity of about 100 watts per square meter — comparable to sunlight exposure.”

The Deadly Toll of ARDS

ARDS is a severe lung condition that affects roughly 10% of intensive care unit patients and carries a mortality rate of 30-40%, even with modern ventilation techniques. Using a pig model of ARDS, the team examined how ventilator energy is transferred and dissipated in the lungs.

The researchers found that reducing this type of energy dissipation led to rapid recovery, while patients continued to deteriorate when 5-10% of alveoli underwent repetitive recruitment/derecruitment.

Rethinking Ventilation Strategies

The study suggests that minimizing these repetitive collapse-and-reopening cycles could significantly reduce ventilator-induced lung injury. Researchers noted that adjusting ventilation strategies to prevent such events may improve outcomes for critically ill patients.

The study’s findings could also help inform the development of new ventilation protocols aimed at reducing lung injury and improving patient care in intensive care units worldwide.

The Future of Mechanical Ventilation

“Follow-up steps should include developing real-time monitoring devices to quantify reopening events and integrating this data into treatment strategies to optimize ventilation and improve patient outcomes,” Gaver said.

Reference: “Mechanical ventilation energy analysis: Recruitment focuses injurious power in the ventilated lung” 3 March 2025, Proceedings of the National Academy of Sciences.
DOI: 10.1073/pnas.2419374122

This research was completed in collaboration with the University of Vermont, the State University of New York Upstate Medical University (SUNY Upstate) and the University of Maryland Shock Trauma Center.

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