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. 2021 Oct 29;37:30. doi: 10.1186/s42826-021-00108-x

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© The Author(s) 2021

Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.

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Fig. 1 — Ventilator-induced lung injury. A Mechanical ventilation with insufficient PEEP can lead to collapse of the alveoli, leading to atelectrauma. Inspiration and expiration from the mechanical ventilator will lead to the alveoli being repeatedly opened and collapsed, which will lead to shear stress and injury. B Inappropriately high pressure/tidal volume settings from the mechanical ventilator can lead to overdistension of the distal bronchi and alveoli, leading to volu/barotrauma injury and barrier disruption. C The damage caused by atelectrauma and volu/barotrauma cumulatively can lead to activation of immune and epithelial cells, causing an excessive inflammatory response which can lead to an influx of inflammatory mediators (TNF-α, IL-1β, IL-6 and IL-8), resulting in what is called biotrauma. Figure created with BioRender.com