Acute lung injury (ALI) remains a significant source of morbidity and mortality in the critically ill patient population. Defined by a set of clinical criteria (acute onset of bilateral pulmonary infiltrates with hypoxemia without evidence of hydrostatic pulmonary edema), ALI has a high incidence (200,000 per year in the United States) and all-cause mortality remains high. The pathogenesis of ALI is explained by damage to both the vascular endothelium and the alveolar epithelium. Recent advances in the understanding of pathophysiology have identified several biomarkers that are associated with poorer clinical outcomes. NHLBI ARDS Network Phase III clinical trials improved survival and reduced duration of mechanical ventilation with a pulmonary protective ventilation strategy and fluid conservative protocol. Possible areas for future treatments are nutritional strategies, statin therapy and mesenchymal stem cells.

Keywords: acute respiratory distress syndrome (ARDS), pulmonary edema, acute respiratory failure

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