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In the acute respiratory distress syndrome (ARDS), surface tension,  T , is likely elevated. And mechanical ventilation of ARDS patients causes ventilation-induced lung injury (VILI), which is believed to be proportional to  T . However, the mechanisms through which elevated  T  may contribute to VILI have been under-studied. This conceptual analysis considers experimental and theoretical evidence for static and dynamic mechanical mechanisms, at the alveolar scale, through which elevated  T  exacerbates VILI; potential causes of elevated  T  in ARDS; and  T -dependent means of reducing VILI. In the last section, possible means of reducing  T  and improving the efficacy of recruitment maneuvers during mechanical ventilation of ARDS patients are discussed.

frontiers in physiology

The Contribution of Surface Tension-Dependent Alveolar Septal Stress Concentrations to Ventilation-Induced Lung Injury in the Acute Respiratory Distress Syndrome