Tuesday, August 10, 2010

The latest review of ALI and ARDS

---published in the BJMP is available as free full text.

There is not a whole lot that’s new regarding ALI/ARDS but this review made some points that have not received much attention elsewhere:

Long term outcomes relate to neuromuscular, neurocognitive and psychological problems rather than pulmonary dysfunction (except in those patients who develop pulmonary fibrosis, sometimes accompanied by pulmonary hypertension).

For reporting purposes most cases are captured in the ICU. However, it is believed that there is a significant number of patients on the wards and in other settings who would meet criteria for ARDS/ALI but are not identified, reflecting the wide ranging severity and heterogeneity of the syndrome.

Some patients do not resolve their ARDS and progress to a fibrotic phase resulting in chronic PFT abnormalities and pulmonary hypertension.

The use of high levels of PEEP (above that called for by the ARDSnet PEEP scale) has not been validated conclusively although a recent meta-analysis suggests that it may be beneficial in a subset of patients with severe disease. However, the optimal level in such cases is not known.

ECMO deserves consideration as a rescue measure in patients with severe hypoxemia refractory to conventional measures.

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