Chest
ReviewsTreatment of ARDS
Section snippets
Standard Supportive Therapy
Standard supportive therapy for ALI/ARDS is directed toward identification and management of pulmonary and nonpulmonary organ dysfunction.
Potential New Treatment Strategies for ALI/ARDS
Several promising new approaches for improving pulmonary gas exchange are currently being assessed in clinical trials and could contribute further to improved outcomes in patients with ALI/ARDS. It is important to realize, however, that mortality in patients with ALI/ARDS is closely related to factors such as hepatic failure and severe infections.101173129 Reduction of mortality in these patients may require improved management of the conditions that cause or contribute to the dysfunction of
Conclusion
The decrease in ALI/ARDS mortality reported since 1991254255 is attributable to improvements in many aspects of care, such as ventilator management, diagnosis and treatment of infections, and nutritional support. However, mortality is still high, and some survivors suffer with various sequelae for months after recovery from critical illness.256257 Thus, further improvements in treatment are needed.
Improved understanding of the pathogenesis of ALI/ARDS has led to important advances in the
Acknowledgment
We appreciate the assistance of Rebecca Cleff in preparing this article.
References (257)
- et al.
Acute respiratory distress in adults
Lancet
(1967) - et al.
Interobserver variability in applying a radiographic definition for ARDS
Chest
(1999) Conference summary: acute lung injury
Chest
(1999)Least PEEP: primum non nocere [editorial]
Chest
(1985)- et al.
Mechanisms of decreased left ventricular preload during continuous positive pressure ventilation in ARDS
Chest
(1986) - et al.
Cardiorespiratory effects of pressure-controlled ventilation with and without inverse ratio in the adult respiratory distress syndrome
Chest
(1993) - et al.
Improved survival in ARDS patients associated with a reduction in pulmonary capillary wedge pressure
Chest
(1990) - et al.
Definitions for sepsis and organ failure and guidelines for the use of innovative therapies in sepsis
Chest
(1992) - et al.
The adult respiratory distress syndrome: a report of survival and modifying factors
Chest
(1992) - et al.
Elevation of cardiac output and oxygen delivery improves outcome in septic shock
Chest
(1992)
Randomized double-blind, multicenter study of prostaglandin E1 in patients with the adult respiratory distress syndrome: Prostaglandin E1Study Group
Chest
The acute respiratory distress syndrome
N Engl J Med
Consensus conference definitions for sepsis, septic shock, acute lung injury, and acute respiratory distress syndrome: time for a reevaluation
Crit Care Med
Pulmonary edema and acute lung injury
Acute lung injury and the acute respiratory distress syndrome
Crit Care Med
Laparotomy for abdominal sepsis in the critically ill
Br J Surg
Laparotomy for intra-abdominal sepsis in patients in an ICUs
Arch Surg
Identification of patients with acute lung injury: predictors of mortality
Am J Respir Crit Care Med
Causes of mortality in patients with the adult respiratory distress syndrome
Am Rev Respir Dis
Ventilation with end-expiratory pressure in acute lung disease
J Clin Invest
Pathologic features and mechanisms of hypoxemia in adult respiratory distress syndrome
Am Rev Respir Dis
Relationships between lung CT density, gas exchange, and PEEP in acute respiratory failure
Anesthesiology
Preservation of normal lung regions in the adult respiratory distress syndrome: analysis by computed tomography
JAMA
Lung edema caused by high peak inspiratory pressures in dogs: role of increased microvascular filtration pressure and permeability
Am Rev Respir Dis
Mechanisms of ventilator-induced lung injury
Crit Care Med
Histopathologic pulmonary changes from mechanical ventilation at high peak airway pressures
Am Rev Respir Dis
Experimental pulmonary edema due to intermittent positive pressure ventilation with high inflation pressures: protection by positive end-expiratory pressure
Am Rev Respir Dis
Severe impairment in lung function induced by high peak airway pressure during mechanical ventilation: an experimental study
Am Rev Respir Dis
Deleterious effects of mechanical ventilation on the lower lung [in French]
Rev Mal Respir
Mechanical ventilation-induced pulmonary edema: interaction with previous lung alterations
Am J Respir Crit Care Med
Permissive hypercapnia
Respir Care
Low mortality associated with low volume pressure limited ventilation with permissive hypercapnia in severe adult respiratory distress syndrome
Intensive Care Med
Low mortality rate in adult respiratory distress syndrome using low-volume, pressure-limited ventilation with permissive hypercapnia: a prospective study
Crit Care Med
Permissive hypercapnia: how permissive should we be?
Am J Respir Crit Care Med
Tidal volume reduction for prevention of ventilator-induced lung injury in acute respiratory distress syndrome: the Multicenter Trail Group on Tidal Volume Reduction in ARDS
Am J Respir Crit Care Med
Evaluation of a ventilation strategy to prevent barotrauma in patients at high risk for acute respiratory distress syndrome: Pressure- and Volume-Limited Ventilation Strategy Group
N Engl J Med
Prospective, randomized, controlled clinical trial comparing traditional versus reduced tidal volume ventilation in acute respiratory distress syndrome patients
Crit Care Med
Ventilation with lower tidal volumes as compared with traditional tidal volumes for acute lung injury and the acute respiratory distress syndrome
N Engl J Med
Time course of changes in lung permeability and edema in the rat exposed to 100% oxygen
J Appl Physiol
Responses of baboons to prolonged hyperoxia: physiology and qualitative pathology
J Appl Physiol
Increase in pulmonary capillary permeability in dogs exposed to 100% O2
J Appl Physiol
Pulmonary inflammation due to oxygen toxicity: involvement of chemotactic factors and polymorphonuclear leukocytes
Am Rev Respir Dis
Oxygen toxicity
Pulmonary oxygen toxicity: a review
Pharmacol Rev
Oxygen toxicity in man: a prospective study in patients with irreversible brain damage
N Engl J Med
Potentiation of diffuse lung damage by oxygen: determining variables
Am Rev Respir Dis
Superoxide dismutase and pulmonary oxygen toxicity
Am J Physiol
Oxygen toxicity: augmentation of antioxidant defense mechanisms in rat lung
Am J Physiol
Simultaneous exposure of sheep to endotoxin and 100% oxygen
Am Rev Respir Dis
Endotoxin protection against oxygen-induced acute and chronic lung injury
J Appl Physiol (Respir Environ Exer Physiol)
Cited by (0)
This article was supported by National Institutes of Health grants RO1-HL51856 (Drs. Matthay and Ware), NO1-HR46059 (Dr. Matthay), NO1-HR46063 (Dr. Brower), and the Medical Research Council of Canada (Dr. Berthiaume).