PT  - JOURNAL ARTICLE
AU  - Kallet, Richard H
TI  - Evidence-Based Management of Acute Lung Injury and Acute Respiratory Distress Syndrome
DP  - 2004 Jul 01
TA  - Respiratory Care
PG  - 793--809
VI  - 49
IP  - 7
4099  - http://rc.rcjournal.com/content/49/7/793.short
4100  - http://rc.rcjournal.com/content/49/7/793.full
AB  - 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.