Chest
Conference Summary: Acute Lung Injury
Section snippets
Clinical Definitions and Epidemiology
Dr. Petty led off this year's conference with a brief historical perspective of the term, adult respiratory distress syndrome (ARDS). His original intention was not to exclude children; in fact, two of the first patients he described in his original description of ARDS were 11 and 15 years old.1 Therefore, Dr. Petty agreed that ARDS should refer to the acute respiratory distress syndrome.
Since the 1993 Aspen Lung Conference 5 years ago, a North American-European Consensus Conference considered
Pathogenesis
Since the 1993 Aspen Acute Lung Injury Conference, there has been substantial progress in understanding the complex inflammatory mechanisms that mediate acute lung injury. The primary focus has continued to be on neutrophil-mediated lung injury, although work presented by Dr. Dayer emphasized the potential contribution of T lymphocytes and monocytes, particularly in the later phase of lung injury. There is new information on the important role of anti-inflammatory cytokines, including
Resolution of Lung Injury
Rapid progress has been made in understanding the basic transport mechanisms that regulate clearance of alveolar edema fluid.15, 16, 17, 18, 19, 20 Sodium is actively transported, primarily by sodium channels on the apical surface of type II cells. Recently, an important ENaC was cloned. This channel is widely distributed in epithelia in several organs including the lung epithelium. After sodium is taken up by ENaC and other sodium channels on type II cells, the sodium pumps (NaK-ATPase),
Biological Markers in Clinical Lung Injury
A substantial number of studies have been carried out over the last 15 years to examine the pathogenetic and prognostic value of biological markers in patients at risk for developing ARDS or in the early phase of ARDS.28 The measurements have been made in the plasma, pulmonary edema fluid, or in BAL fluid. At this year's conference, there were promising new data.
Dr. V. Newman presented evidence that an integral membrane antigen of alveolar epithelial type I cells (HTI-56) could be quantified in
Clinical Trials
In the last 5 years, there have been several major clinical trials that have tested new therapeutic approaches for patients with ARDS. Although there was not time at this year's lung conference to discuss the details of these trials, this report includes a brief summary of the results of some of the major trials.
A major development since the 1993 Aspen Lung Conference on Acute Lung Injury was the commitment of the Lung Division of the NIH to establish an ARDS Network of 10 university medical
Conclusion
In summary, the 1998 Thomas L. Petty Acute Lung Injury Conference in Aspen, CO, was a great success. Basic and clinical investigators presented a broad range of new insights into the mechanisms responsible for acute lung injury, the pathophysiology that sustains lung injury, and potential opportunities for new therapeutic strategies. There has been significant progress in identifying potentially useful biological markers for both pathogenesis and prognosis, and major new insights have been
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2014, Parasitology InternationalCurrent Knowledge of Acute Lung Injury and Acute Respiratory Distress Syndrome
2012, Critical Care Nursing Clinics of North AmericaCitation Excerpt :Fig. 2 demonstrates current understanding of the complex changes beginning with the proliferative processes and proceeding through resolution of the ALI. Important changes associated with this phase include epithelial repopulation, reabsorption of the alveolar fluid, clearing of the protein residue associated with the influx of the edema fluid observed in the exudative phase of lung injury, and finally resolution of fibrosis.6,7,26,27 The discovery of long-term effects on the pulmonary function of survivors associated with the onset and resolution of ALI has provided additional impetus to the systematic evaluation of quality-of-life (QOL) measures in this population.
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2010, Evidence-Based Practice of Critical Care: Expert Consult: Online and PrintThe role of apoptosis in the pathophysiology of Acute Respiratory Distress Syndrome (ARDS): An up-to-date cell-specific review
2010, Pathology Research and PracticeCitation Excerpt :The pathophysiology of ARDS is characterized by complex mechanisms that involve cells of inflammation, lung tissue cells, cytokines, chemokines, as well as apoptosis activators and inhibitors [4]. Histologically, ARDS is characterized by lung epithelial and endothelial cell injury, neutrophil influx, hyaline membrane formation and alveolar edema and hemorrhage [4,8]. Recent studies have shown that apoptosis contributes to ARDS pathogenesis [4,8–13].
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2010, Evidence-Based Practice of Critical Care
Supported in part by NIH HL51854 and HL51856.