CRC ACUTE RESP DISTRSS SYNDRM PDF

PREFACE

The acute respiratory distress syndrome, also known as acute lung injury, is a major cause of acute respiratory failure in critically ill patients. The syndrome was originally described by Dr. Thomas Petty in 1967 (see Dr. Petty's overview in Chapter 1). Over the last three decades, clinical and experimental studies have evaluated the pathophysiology, pathogenesis, and treatment for clinical lung injury. During this time, remarkable progress has been made in understanding the molecular, cellular, and physiological basis for the development and resolution of acute lung injury. Furthermore, there is recent evidence that mortality in patients with acute lung injury can be reduced with a lungprotective ventilatory strategy. However, more progress is needed to fill in major gaps in our understanding of how acute lung injury develops, as well as how it resolves. This volume in the Lung Biology in Health and Disease series is designed to integrate both basic science and clinical research in order to provide a comprehensive perspective on the status of research and treatment of the acute respiratory distress syndrome and clinical acute lung injury.

In Chapter 1 Dr. Petty provides an overview regarding historical aspects of the acute respiratory distress syndrome. In Chapter 2 there is a comprehensive discussion of clinical characteristics, clinical definitions, as well as the important clinical risk factors for developing acute lung injury. Chapter 3 provides an update on the epidemiology of acute lung injury. Recent data indicate that the incidence of acute lung injury is substantial, similar to the original estimate from the National Heart, Lung, and Blood Institute in 1977, approximately 150,000–200,000 patients per year in the United States alone. Chapter 4 provides an overview of radiographic characteristics, including findings from computerized axial tomography. Chapter 5 is a review of the pathological findings in clinical lung injury, including both ultrastructural and routine histological findings. The pathogenesis of acute lung injury is discussed in Chapter 6 (experimental studies) and Chapter 7 (clinical studies). Chapter 8 considers the role of apoptosis in the pathogenesis and resolution of lung injury. Important advances in understanding ventilator-induced lung injury based on both clinical and experimental studies is discussed in Chapter 9. The role of sepsis in the development of lung injury is reviewed in Chapter 10. New data are available on the potential role of heat-shock proteins in the pathophysiology of acute lung injury, a topic covered in Chapter 11. In some patients fibrosing alveolitis develops during the course of acute lung injury, a topic that is discussed in Chapter 12.

A new area in research in clinical acute lung injury and the acute respiratory distress syndrome is the influence of genetic factors in determining which patients are most susceptible to the development of acute lung injury. Chapters 13 and 14 are devoted to this new topic. Chapter 15 focuses on experimental and clinical studies of the resolution of lung injury with a particular emphasis on the resolution of alveolar edema.

The remaining chapters in this volume focus on issues that pertain directly to treatment. Chapter 16 considers treatment of sepsis, the most lethal cause of clinical acute lung injury. Chapter 17 considers how pulmonary hypertension in clinical acute lung injury can be treated. Chapter 18 reviews the clinical studies of glucocorticoid therapy for the acute respiratory distress syndrome. Chapter 19 discusses clinical trials of surfactant replacement in patients with lung injury, and Chapter 20 provides an update on the potential role of prone position for the treatment of patients with clinical lung injury. Chapter 21 provides a combined American and European perspective on lung-protective strategies for patients with clinical lung injury. Chapter 22 provides a brief overview of an important new cause of viral pneumonia, severe acute respiratory syndrome (SARS), an illness that can lead to clinical acute lung injury. The final chapter provides a brief overview of selected areas in which important progress has been made as well as a perspective on potential opportunities for future research and treatment of acute lung injury.

I appreciate the hard work of each of the contributors to this edition as well as the excellent editorial supervision provided by Rebecca Cleff, Moraima Suarez, Sandra Beberman, and Dr. Claude Lenfant.