• Laura R A Schouten, Marcus J Schultz, Anton H van Kaam, Nicole P Juffermans, Albert P Bos, and Roelie M Wösten-van Asperen.
• From the Departments of Pediatric Intensive Care (L.R.A.S., A.P.B., R.M.W.-v.A.), Intensive Care and Laboratory of Experimental Intensive Care and Anesthesiology (L.R.A.S., M.J.S., N.P.J.), and Neonatology (A.H.v.K.), Academic Medical Center, Amsterdam, The Netherlands.
• Anesthesiology. 2015 Aug 1;123(2):389-408.

BackgroundAdvanced age is associated with an increased susceptibility and mortality of the acute respiratory distress syndrome. This may be due to the progressive changes in innate immune responses and intrinsic properties of the lung that occur during the process of aging. Therefore, this study assesses the association between maturation and aging and pulmonary responses to injury in animal models of lung injury.MethodsA systematic search was conducted in PubMed, EMBASE (up to June 2014) and in the references of relevant articles to identify the studies using in vivo models of lung injury caused by an acute pulmonary insult, in which at least two age groups were compared. Because methodological diversity precluded combining these studies in a quantitative meta-analysis, data are presented based on the qualitative comparison with the adult group.ResultsOf the 2,840 identified studies, 51 were included in this review. Most studies showed that, in response to a pulmonary insult, increasing age is associated with more pulmonary inflammation, edema, alveolar damage, and higher mortality. In addition, results indicate the existence of age-dependent changes in key components of the intracellular signaling pathways involved in the inflammatory response.ConclusionsIncreasing age seems to be correlated with exaggerated pulmonary responses to injury, ultimately leading to more severe lung injury. Pulmonary inflammation seems relatively suppressed in infants/juveniles, whereas in the middle aged/elderly, the inflammatory response seems delayed but aggravated. This implies that investigators and clinicians need to use caution about extrapolating results from adolescent or youngadult animals to pediatric or elderly patients in clinical practice.

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