Acute Lung Injury Introduction

• Acute Lung Injury (ALI) is a distinct form of acute respiratory failure characterized by diffuse pulmonary infiltrates, progressive hypoxemia, reduced lung compliance and normal hydrostatic pressures

In 1967 Ashbaugh and colleagues (1) (2)published a case series in the Lancet which described a clinical syndrome, which they (later) termed “Adult Respiratory Distress Syndrome” (ARDS) (3). The 12 patients involved complained of acute respiratory distress, cyanosis refractory to oxygen therapy, decreased lung compliance and diffuse pulmonary infiltrates on chest x-ray.

Trauma doctors involved in treating victims of war had long been familiar with this syndrome, which came to be known as “wet lung”, “shock lung” or “Da-nang lung”. This problem had been identified during World War II but with the advent of advanced trauma (M.A.S.H. units during the Vietnam war) the prevalence of this form of respiratory failure was truly recognized.
Over the past 30 or so years, this syndrome has come to be one of the central problems of intensive care: lung injury arising from a variety of different etiologies, each characterized by bilateral diffuse infiltrates on x-ray, hypoxemia, and non-cardiogenic pulmonary edema.

Learning Objectives

• To understand the pathology and pathophysiology of ALI/ARDS
• To devise a ventilation strategy for these patients.
• To introduce the concept of ventilator induced lung injury
• To address adjunct and rescue therapy for patients with resistant hypoxemia.

Copyright Patrick Neligan 2001-2002

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