Regenerative ventilation proposed as a hypothesis for ARDS lung repair

Mechanical ventilation remains central to supportive care in acute respiratory distress syndrome (ARDS), with low tidal volume ventilation and other lung-protective strategies aimed at limiting ventilator-induced lung injury. The authors introduce “regenerative ventilation” as a hypothesis-driven extension: within established lung-protection boundaries, regional mechanical conditions might also influence lung recovery. They draw on experimental evidence that mechanical signals can affect alveolar cell biology, including findings from pneumonectomy models, while noting that these models differ substantially from ARDS.

The proposed “regenerative strain window” describes a hypothetical range of regional cyclic deformation that could limit injurious stress while preserving signals relevant to repair. The authors stress that neither its boundaries nor its existence in human ARDS has been established. Global tidal volume may not reflect regional deformation, which can vary with recruitment, PEEP, and the heterogeneous mechanics of injured lungs. Tools such as electrical impedance tomography, quantitative CT, ultrasound, and esophageal pressure may help characterize lung mechanics, but they do not directly establish a repair-promoting target.

The immediate clinical objective remains established lung protection. This is a conceptual framework, not evidence for changing ventilation practice: whether clinically relevant deformation influences repair in human ARDS, and whether it can be measured and modified safely, requires experimental and clinical study.