Chest
Volume 116, Supplement 1, July 1999, Pages 119S-126S
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Conference Summary: Acute Lung Injury

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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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