title: Understanding and managing fluid balance in patients with acute lung injury.
abstract: OBJECTIVE
  Acute lung injury (ALI) and the acute respiratory distress syndrome (ARDS) affect hundreds of thousands of people each year worldwide, resulting in a significant healthcare burden. Over the past four decades, much has been discovered regarding the pathophysiology of lung injury, yet little progress has been made in advancing effective treatment strategies. In this article, we discuss the current knowledge as to fluid balance in the pathophysiology of ALI/ARDS and the recent innovations that have been described related to manipulations of hydrostatic or oncotic pressure in this condition.
  
  
  RESULTS
  Hypoproteinemia is a clear marker for ALI/ARDS and may play a pathophysiologic role given its independent prognostic value. Fluid balance and oncotic pressure alterations induced by diuretic and colloid therapy improve respiratory physiology and likely alter net flux of fluid across the injured capillary-alveolar membrane. Chest radiographs serve as a useful adjunctive tool in monitoring longitudinal fluid balance manipulations in ALI/ARDS.
  
  
  CONCLUSIONS
  Manipulation of Starling forces in established ALI/ARDS produces significant physiologic benefit and may influence outcome. Future research should focus on determining a mortality benefit with this readily available intervention.
authors.affiliation: Division of Pulmonary, Allergy and Critical Care, Department of Medicine, Emory University School of Medicine Atlanta, Georgia, USA.
authors.forename: Charmaine A
authors.initials: CA
authors.lastname: Lewis
authors.forename: Greg S
authors.initials: GS
authors.lastname: Martin
mesh_terms: D003131:Combined Modality Therapy; D015633:Extravascular Lung Water; D005440:Fluid Therapy; D006801:Humans; D006874:Hydrostatic Pressure; D007019:Hypoproteinemia / Q000503:physiopathology; D009997:Osmotic Pressure; D012128:Respiratory Distress Syndrome / Q000175:diagnosis* / Q000503:physiopathology / Q000628:therapy; D014883:Water-Electrolyte Imbalance / Q000175:diagnosis* / Q000628:therapy