Paediatric respiratory reviews
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The clinical course of acute lung injury (ALI) is a complex and variable process accompanied by severe lung dysfunction, which persists for a long period of time with variable recovery of pulmonary function. The extent and severity of the lung disease associated with ALI varies with those patients having the most severe manifestations of lung disease being grouped as acute respiratory distress syndrome (ARDS). The pathological injury associated with this disease process, termed diffuse alveolar damage (DAD), has three overlapping phases (exudative, proliferative and fibrotic) which are the consequences of severe injury to the alveolar-capillary unit. ⋯ Those areas that demonstrate the major advances within the field are highlighted because of the diverse and vast nature of the cellular components involved in the process of ALI. We are beginning to identify those processes that contribute to the cellular derangements which are the hallmark of ALI. By expanding our understanding of those factors, we should in the future be able to construct therapeutic interventions that address the aetiology of ALI.
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Paediatr Respir Rev · Mar 2001
ReviewAcute lung injury: pathophysiology, assessment and current therapy.
Acute respiratory distress syndrome (ARDS) is a clinically defined entity describing the severity of diffuse alveolar injury caused by direct or indirect injury to the lung. Pathophysiology, clinical course and outcome of ARDS depend on the underlying cause, the severity of the disease and co-morbidities. ⋯ This includes recruitment manoeuvres and the use of high PEEP to open the atelectatic lung and the use of permissive hypercapnia and the limitation of peak inspiratory pressure below 35 cm H2O to avoid overinflation. The clinical benefit of newer modes of ventilatory support such as inverse ratio ventilation, high frequency oscillatory ventilation, surfactant replacement, prone positioning and inhaled nitric oxide has yet to be determined in children.