Therapeutic strategies for severe acute lung injury.
OBJECTIVE
In the management of patients with severe acute lung injury and acute respiratory distress syndrome, clinicians are sometimes challenged to maintain acceptable gas exchange while avoiding harmful mechanical ventilation practices. In some of these patients, physicians may consider the use of "rescue therapies" to sustain life. Our goal is to provide a practical, evidence-based review to assist critical care physicians' care for patients with severe acute lung injury and acute respiratory distress syndrome.


METHODS
We searched the PubMed database for clinical trials that examined the use of the following therapies in severe acute lung injury and acute respiratory distress syndrome: recruitment maneuvers, high positive end-expiratory pressure, prone position, high-frequency oscillatory ventilation, glucocorticoids, inhaled nitric oxide, buffer therapy, and extracorporeal life support.


METHODS
All clinical trials that included patients with severe acute lung injury and acute respiratory distress syndrome were included in the review.


RESULTS
The primary author reviewed the aforementioned trials in depth and then disputed findings and conclusions with the other authors until consensus was achieved.


CONCLUSIONS
This article is designed to provide clinicians with a simple bedside definition for the diagnosis of severe acute respiratory distress syndrome; to describe several therapies that can be used for severe acute respiratory distress syndrome with an emphasis on the potential risks and the indications and benefits; and to offer practical guidelines for implementation of these therapies.
Diaz
Janet V
JV
University of California, San Francisco, San Francisco, CA, USA. diazj@who.int
Brower
Roy
R
Calfee
Carolyn S
CS
Matthay
Michael A
MA
D055371:Acute Lung Injury / Q000175:diagnosis / Q000401:mortality* / Q000628:therapy*; D000305:Adrenal Cortex Hormones / Q000627:therapeutic use; D002423:Cause of Death; D003131:Combined Modality Therapy; D003422:Critical Care / Q000379:methods; D019317:Evidence-Based Medicine; D015199:Extracorporeal Membrane Oxygenation / Q000379:methods; D005260:Female; D006801:Humans; D008297:Male; D009569:Nitric Oxide / Q000627:therapeutic use; D011175:Positive-Pressure Respiration; D016032:Randomized Controlled Trials as Topic; D012128:Respiratory Distress Syndrome / Q000175:diagnosis / Q000401:mortality* / Q000628:therapy*; D018570:Risk Assessment; D012720:Severity of Illness Index; D016019:Survival Analysis; D016896:Treatment Outcome
D000305:Adrenal Cortex Hormones; D009569:Nitric Oxide