This Article Full Text Free Full Text (PDF) Free Submit a response Alert me when this article is cited Alert me when eLetters are posted Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in ISI Web of Science Similar articles in PubMed Alert me to new issues of the journal Add to My Personal Article Archive Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via ISI Web of Science (12) Citing Articles via Google Scholar Google Scholar Articles by Calfee, C. S. Articles by Matthay, M. A. Search for Related Content PubMed PubMed Citation Articles by Calfee, C. S. Articles by Matthay, M. A. Related Content Contemporary Reviews in Critical Care Medicine

Nonventilatory Treatments for Acute Lung Injury and ARDS*

Department of Medicine, Division of Pulmonary and Critical Care Medicine, University of California at San Francisco, San Francisco, CA.

Correspondence to: Carolyn S. Calfee, MD, University of California, San Francisco, Pulmonary and Critical Care Division, 505 Parnassus Ave, San Francisco, CA 94143-0130; e-mail: carolyn.calfee{at}ucsf.edu

Abstract

Over the past decade, advances in the ventilatory management of acute lung injury (ALI) and ARDS have improved outcomes; however, until recently the search for other therapies has been less fruitful. Recently, the Acute Respiratory Distress Syndrome Network Fluid and Catheter Treatment Trial reported that a conservative fluid management strategy, compared with a fluid liberal strategy, increased the mean (± SE) number of ventilator-free days in patients with ALI (14.6 ± 0.5 vs 12.1 ± 0.5 days, respectively; p < 0.001). In addition to this beneficial effect on outcomes, the study found that the conservative fluid strategy did not increase the incidence of renal failure or the development of shock. Other studies have demonstrated that albumin and furosemide therapy may be beneficial in hypoproteinemic patients with lung injury, though data on outcomes is still lacking. Although several pharmacologic therapies, such as corticosteroids, surfactant, and nitric oxide, have been demonstrated to be ineffective in improving outcomes, several promising new treatments are being investigated in ongoing or upcoming clinical trials. This article reviews these developments and other recent research on the optimal nonventilatory management of patients with ALI.

Key Words: acute lung injury • fluid therapy • management • pulmonary edema

This article has been cited by other articles:

				W. S. Lyons, C. S. Calfee, and M. A. Matthay Nonventilatory Treatments for ARDS?: Future Directions Chest, February 1, 2008; 133(2): 586 - 587. [Full Text] [PDF]

				M. Ikegami, E. A. Scoville, S. Grant, T. Korfhagen, W. Brondyk, R. K. Scheule, and J. A. Whitsett Surfactant Protein-D and Surfactant Inhibit Endotoxin-Induced Pulmonary Inflammation Chest, November 1, 2007; 132(5): 1447 - 1454. [Abstract] [Full Text] [PDF]

				J. I. F. Salluh and M. Soares Methylprednisolone Infusion in Early Severe ARDS: It Is Pretty, But Is It Art? Chest, September 1, 2007; 132(3): 1096 - 1096. [Full Text] [PDF]

				R. H. Savel, E. B. Goldstein, H. Lehman, Y. Kupfer, and D. Annane Methylprednisolone Infusion in Early Severe ARDS Chest, September 1, 2007; 132(3): 1096 - 1097. [Full Text] [PDF]

				G. U. Meduri, P. E. Marik, S. M. Pastores, D. Annane, C. S. Calfee, and M. A. Matthay Corticosteroids in ARDS: A Counterpoint Chest, September 1, 2007; 132(3): 1093 - 1094. [Full Text] [PDF]