Update on acute lung injury and critical care medicine 2009.

Abstract

This article reviews selected contributions published in 2009 regarding the epidemiology, clinical course, pathogenesis, and treatment of acute lung injury (ALI). Articles in critical care medicine that relate to multiorgan failure are also included. Research on epidemiology and genetic contributions to ALI have opened several promising areas for future studies to establish the environmental and genetic factors that influence its development and outcomes. Novel discoveries have been made on the likely role of platelets and lymphocytes in the pathogenesis and resolution of ALI. Animal and clinical studies have provided new insights regarding the mechanisms that initiate and sustain ALI and the value of both biological and clinical factors for predicting outcome in ALI. Based on preclinical studies, cell-based treatment for ALI, acute renal failure, and septic shock represents a new direction that may eventually have clinical value for therapy of critically ill patients with organ failure. The results of a multicenter randomized trial demonstrated that mortality in critically ill patients was not altered by high- compared with low-intensity renal replacement therapy. In another large randomized trial, tight glucose control worsened mortality in critically ill patients compared with conventional control. Because the topic is broad, our comments are restricted to a subset of a number of highly meritorious publications, although we included citations for several other articles published in 2009. We primarily focused on discoveries regarding epidemiology, definitions, genetics, clinical course, pathogenesis, and new treatments, including publications from both clinical and experimental studies.