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Treatment of ARDS^*

^* From Johns Hopkins University (Dr. Brower), Baltimore, MD; the University of Montreal (Dr. Berthiaume), Montreal, Canada; and the Cardiovascular Research Institute (Drs. Ware and Matthay), The University of California at San Francisco, San Francisco, CA.

Correspondence to: Michael A. Matthay, MD, FCCP, Moffitt Hospital, Room M-917, University of California, 505 Parnassus Ave, San Francisco, CA 94143-0624; e-mail: mmatt{at}itsa.ucsf.edu

Improved understanding of the pathogenesis of acute lung injury (ALI)/ARDS has led to important advances in the treatment of ALI/ARDS, particularly in the area of ventilator-associated lung injury. Standard supportive care for ALI/ARDS should now include a protective ventilatory strategy with low tidal volume ventilation by the protocol developed by the National Institutes of Health ARDS Network. Further refinements of the protocol for mechanical ventilation will occur as current and future clinical trials are completed. In addition, novel modes of mechanical ventilation are being studied and may augment standard therapy in the future. Although results of anti-inflammatory strategies have been disappointing in clinical trials, further trials are underway to test the efficacy of late corticosteroids and other approaches to modulation of inflammation in ALI/ARDS.

Key Words: acute lung injury • mechanical ventilation • pulmonary edema • ventilator-associated lung injury

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