The utility of clinical predictors of acute lung injury: towards prevention and earlier recognition.
Despite significant advances in our understanding of the pathophysiology of acute lung injury, a lung-protective strategy of mechanical ventilation remains the only therapy with a proven survival advantage. Numerous pharmacologic therapies have failed to show benefit in multicenter clinical trials. The paradigm of early, goal-directed therapy of sepsis suggests greater clinical benefit may derive from initiating therapy prior to the onset of respiratory failure that requires mechanical ventilation. Thus, there is heightened interest in more accurate and complete characterization of high-risk patient populations and identification of patients in the early stage of acute lung injury, prior to the need for mechanical ventilation. This article discusses the growing literature on clinical predictors of acute lung injury (including risk factors for specific subgroups) with an emphasis on transfusion-related risk factors and recent research targeting the early identification of high-risk patients and those with early acute lung injury prior to the onset of respiratory failure.
Division of Pulmonary/Critical Care, Stanford University, 300 Pasteur Drive, MC 5236 Stanford, CA 94305, USA. jlevitt@stanford.edu
Joseph E
JE
Levitt
Michael A
MA
Matthay
D055371:Acute Lung Injury / Q000175:diagnosis* / Q000209:etiology / Q000517:prevention & control; D015415:Biomarkers / Q000032:analysis*; D018450:Disease Progression; D042241:Early Diagnosis; D019317:Evidence-Based Medicine; D006801:Humans; D016017:Odds Ratio; D011237:Predictive Value of Tests; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome
D015415:Biomarkers