Current opinion in critical care
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Curr Opin Crit Care · Feb 2008
ReviewThe endothelium in acute lung injury/acute respiratory distress syndrome.
Since pulmonary edema from increased endothelial permeability is the hallmark of acute lung injury, a frequently encountered entity in critical care medicine, the study of endothelial responses in this setting is crucial to the development of effective endothelial-targeted treatments. ⋯ Mechanistic studies have delivered several interventions, which are effective in preventing and treating experimental acute lung injury and have thus provided objectives for translational studies. Some of these modalities may evolve into clinically useful tools in the treatment of this devastating illness.
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Curr Opin Crit Care · Feb 2008
ReviewRole of open-lung biopsy in acute respiratory distress syndrome.
When classic examinations such as bronchoalveolar lavage are not contributory in the etiologic diagnosis of unresolving acute respiratory distress syndrome, surgical lung biopsy would appear to be useful to determine the specific cause, particularly infection or postaggressive fibrosis, which could benefit from an adapted treatment. ⋯ Surgical lung biopsy could be proposed for patients with unresolving acute respiratory distress syndrome after 7-10 days of evolution despite well-conducted initial treatment when the etiology of acute respiratory distress syndrome has not been confirmed or when the appearance of postaggressive fibrosis is suspected.
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Curr Opin Crit Care · Feb 2008
ReviewWhat have anatomic and pathologic studies taught us about acute lung injury and acute respiratory distress syndrome?
Acute lung injury and acute respiratory distress syndrome are defined as morphologic and functional manifestations of pulmonary injury of various causes. Acute lung injury and acute respiratory distress syndrome may result from direct effects on epithelial lung cells or from indirect effects on endothelial lung cells, reflecting lung involvement as part of a more distant systemic inflammatory response. This review addresses anatomic/pathologic differences between acute lung injury and acute respiratory distress syndrome lungs. ⋯ An appreciation of the acute respiratory distress syndrome must take into account anatomic/pathologic characteristics, which depend upon the initial cause. Consideration of each pathologic mechanism will permit more precise clinical management and probably improved outcomes.
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Curr Opin Crit Care · Feb 2008
ReviewThe epithelium in acute lung injury/acute respiratory distress syndrome.
The mechanisms of epithelial injury in acute lung injury/acute respiratory distress syndrome have been of interest since the syndrome was first described. Cell therapies to replace injured epithelium are a futuristic dream; however, there is ongoing research to achieve this goal. We review research regarding the function of the epithelium in acute lung injury/acute respiratory distress syndrome, including potential novel therapies. ⋯ Epithelial damage is a hallmark of acute lung injury/acute respiratory distress syndrome. An increased understanding of the function of these cells and of the abnormalities that occur when these lung cells are injured should allow the development of novel therapies and, perhaps, lead to replacement therapies.