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Research Article

Evidence-Based Management of Acute Lung Injury and Acute Respiratory Distress Syndrome

Richard H Kallet
Respiratory Care July 2004, 49 (7) 793-809;
Richard H Kallet
Cardiovascular Research Institute, University of California, San Francisco, and with Respiratory Care Services, Department of Anesthesia, San Francisco General Hospital, University of California, San Francisco
MSc RRT FAARC
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Abstract

This report explores the efficacy of existing therapies for acute lung injury (ALI) and acute respiratory distress syndrome (ARDS), primarily in terms of clinically important outcomes such as the duration of mechanical ventilation and hospital mortality. Of the 15 therapies reviewed, the strongest evidence suggests that ALI/ARDS should be managed with a low-tidal-volume, pressure-limited approach, with either low or moderately high positive end-expiratory pressure. To date there have been few large, sufficiently powered, randomized controlled clinical trials of ALI/ARDS therapies that addressed patient outcomes. However, there is relatively strong evidence to support conservative fluid management and high-fat, anti-oxidant nutritional formulations. Although most pharmacologic ALI/ARDS therapies have been ineffective, high-dose methylprednisolone is indicated in the subgroups of ALI/ARDS patients who have Pneumocystis carinii pneumonia or are at risk of ARDS due to fat embolization.

  • acute lung injury
  • acute respiratory distress syndrome
  • ARDS
  • extracorporeal membrane oxygenation
  • high-frequency ventilation
  • nitric oxide
  • nutritional support
  • liquid ventilation
  • prone position
  • surfactant
  • evidence-based medicine

Footnotes

  • Correspondence: Richard H Kallet MSc RRT FAARC, Respiratory Care Services, San Francisco General Hospital, NH:GA-2, 1001 Potrero Avenue, San Francisco CA. 94110. E-mail: rkallet{at}sfghsom.ucsf.edu.
  • Copyright © 2004 by Daedalus Enterprises Inc.
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Respiratory Care: 49 (7)
Respiratory Care
Vol. 49, Issue 7
1 Jul 2004
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Evidence-Based Management of Acute Lung Injury and Acute Respiratory Distress Syndrome
Richard H Kallet
Respiratory Care Jul 2004, 49 (7) 793-809;

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Evidence-Based Management of Acute Lung Injury and Acute Respiratory Distress Syndrome
Richard H Kallet
Respiratory Care Jul 2004, 49 (7) 793-809;
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Keywords

  • acute lung injury
  • acute respiratory distress syndrome
  • ARDS
  • extracorporeal membrane oxygenation
  • high-frequency ventilation
  • nitric oxide
  • nutritional support
  • liquid ventilation
  • prone position
  • surfactant
  • evidence-based medicine

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