Adult respiratory distress syndrome: diagnosis and management

ARDS yearly afflicts more than 150,000 people, many of whom are young and otherwise healthy and yet the mortality rate remains in excess of 60% to 70%. This high mortality has not yielded to the significant gains made in intensive care patient management and rapid advances in technology. Acute lung injury research in the past 15 to 20 years has greatly enhanced our understanding of the pathophysiologic mechanisms underlying this complicated disorder. Therapeutic goals should be aimed at total patient surveillance and support, including the psychosocial aspects of patient care. Fortunately, basic research has recently yielded promising results with pharmacologic interventions designed to limit lung injury or prompt lung repair. Clinical trials underway and proposed will determine which, if any, of these approaches is effective. Until success is achieved, supportive intensive care with diligent attention to infection control, fluid therapy, nutrition, and ventilator management will remain the focal point of therapy for ARDS.