Furthermore, high stretch can directly induce high production and secretion of inflammatory factors such as IL-6, IL-8 and IL-10, as demonstrated both in vitro and in vivo from cultured airway cells to mechanically ventilated animal models and patients, and these cytokines have been implicated in amplifying lung injury in patients with ARDS under mechanical ventilation [50]. This evidence concerns the gene IL10 and acute respiratory distress syndrome.