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Chest 2001;120;1347-1367
DOI 10.1378/chest.120.4.1347
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. (CHEST 2001; 120:1347–1367)
Key words: acute lung injury; mechanical ventilation; pulmonary edema; ventilator-associated lung injury
Abbreviations: ALI ⫽ acute lung injury; APRV ⫽ airway pressure-release ventilation; ECco2R ⫽ extracorporeal
carbon dioxide removal; ECMO ⫽ extracorporeal membrane oxygenation; Fio2 ⫽ fraction of inspired oxygen;
HFV ⫽ high-frequency ventilation; I:E ⫽ ratio of the duration of inspiration to the duration of expiration;
IL ⫽ interleukin; IMPRV ⫽ intermittent mandatory pressure-release ventilation; IRV ⫽ inverse-ratio ventilation;
LFPPV ⫽ low-frequency positive-pressure ventilation; NIH ⫽ National Institutes of Health; NIPPV ⫽ noninvasive
positive-pressure ventilation; NO ⫽ nitric oxide; PEEP ⫽ positive end-expiratory pressure; PSB ⫽ protected specimen
brushing; TGI ⫽ tracheal gas insufflation; TNF ⫽ tumor necrosis factor
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