Abstract
Acute lung injury (ALI) remains a major cause of morbidity and mortality in critically ill patients. Despite improved understanding of the pathogenesis of ALI, supportive care with a lung protective strategy of mechanical ventilation remains the only treatment with a proven survival advantage. Most clinical trials in ALI have targeted mechanically ventilated patients. Past trials of pharmacologic agents may have failed to demonstrate efficacy in part due to the resultant delay in initiation of therapy until several days after the onset of lung injury. Improved early identification of at-risk patients provides new opportunities for risk factor modification to prevent the development of ALI and novel patient groups to target for early treatment of ALI before progression to the need for mechanical ventilation. This review will discuss current strategies that target prevention of ALI and some of the most promising pharmacologic agents for early treatment of ALI prior to the onset of respiratory failure that requires mechanical ventilation.
Highlights
In 1994, the American and European Consensus Conference (AECC) established specific clinical criteria for acute lung injury (ALI) and acute respiratory distress syndrome (ARDS), providing standardization for clinical research and multicenter clinical trials [1]
The United States Critical Illness and Injury Trials group and the Lung Injury Prevention Study (USCIITGLIPS) investigators have developed the Checklist for Lung Injury Prevention (CLIP) in an attempt to standardize the care of at-risk patients and are currently validating its utility
Angiotensin converting enzyme (ACE) inhibitors and angiotensin receptor blockers (ARBs) have anti-inflammatory properties and have been shown to improve lung function in murine models of lung injury [84,85]; use of these at time of hospital admission was not associated with a reduced incidence of ALI in the Lung Injury Prediction Score (LIPS) cohort [86]
Summary
In 1994, the American and European Consensus Conference (AECC) established specific clinical criteria for acute lung injury (ALI) and acute respiratory distress syndrome (ARDS), providing standardization for clinical research and multicenter clinical trials [1]. Clinical trials have largely targeted enrolling patients within 48 hours of meeting AECC criteria while receiving mechanical ventilation, potentially delaying initiation of treatment until several days after onset of lung injury. In the LIPS cohort, which included admissions for high risk surgeries, prevalence of ALI was 7% and progression to ALI occurred over a median of 2 days (interquartile range 1 to 4 days) [16]. These differences may have important implications when selecting strategies to identify patients within an adequate window to initiate appropriate therapeutic or preventative therapies.
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
