Critical care clinics
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Critical care clinics · Jul 2011
ReviewMechanical ventilation with lung protective strategies: what works?
Essentially all patients with acute lung injury or acute respiratory distress syndrome require mechanical ventilatory assistance to support gas exchange and reduce the work of breathing associated with the lung impairment. Unfortunately, this life-sustaining support may actually cause further lung damage and possibly lead to increased mortality. This article reviews strategies that may help minimize ventilator-induced lung injury.
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Acute respiratory distress syndrome (ARDS) and acute lung injury (ALI) are distinctly modern clinical entities. Recent epidemiologic research has taken advantage of large cohorts in efforts to better describe these highly lethal syndromes with a focus on differentiation of clinically meaningful subtypes and early prediction in an effort to improve treatment and prevention. This article identifies the most significant studies and systematic reviews of recent years, defining the incidence, mortality, risk and prognostic factors, and etiologic classes of ARDS/ALI.
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Acute respiratory distress syndrome (ARDS) is a clinical syndrome of acute respiratory failure presenting with hypoxemia and bilateral pulmonary infiltrates, most often in the setting of pneumonia, sepsis, or major trauma. The pathogenesis of ARDS involves lung endothelial injury, alveolar epithelial injury, and the accumulation of protein-rich fluid and cellular debris in the alveolar space. ⋯ A potential strategy involves cell-based therapies, including mesenchymal stem cells (MSCs). Herein we review basic properties of MSCs, their use in preclinical models of lung injury and ARDS, and potential therapeutic mechanisms.
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Critical care clinics · Jul 2011
ARDS Network (NHLBI) studies: successes and challenges in ARDS clinical research.
To hasten the development of effective therapy for acute respiratory distress syndrome (ARDS), in 1994, the National Heart, Lung, and Blood Institute initiated a clinical network to carry out multicenter clinical trials of ARDS treatments. The ARDS Network is a clinical research network of approximately 42 hospitals, organized into 12 clinical sites. The goal of the Network is to efficiently test promising agents, devices, or management strategies to improve the care of patients with ARDS. Comprehensive information regarding all completed and ongoing ARDSNet clinical trials is available at www.ardsnet.org, but a brief summary is provided in this article.