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10 - Acute lung injury (ALI) and the acute respiratory distress syndrome (ARDS)

Published online by Cambridge University Press:  12 January 2010

By
Scott L. Schissel  and
Bruce D. Levy
Edited by
Michael F. Lubin ,
Robert B. Smith ,
Thomas F. Dodson ,
Nathan O. Spell  and
H. Kenneth Walker
Scott L. Schissel
Affiliation:
Brigham and Women's Hospital and Harvard Medical School, Boston, MA
Bruce D. Levy
Affiliation:
Brigham and Women's Hospital and Harvard Medical School Boston, MA
Michael F. Lubin
Affiliation:
Emory University, Atlanta
Robert B. Smith
Affiliation:
Emory University, Atlanta
Thomas F. Dodson
Affiliation:
Emory University, Atlanta
Nathan O. Spell
Affiliation:
Emory University, Atlanta
H. Kenneth Walker
Affiliation:
Emory University, Atlanta
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Summary

Introduction and definitions

Acute lung injury (ALI) is a devastating disorder caused by many underlying medical and surgical diseases; and, when complicated by severe hypoxemia, is termed the acute respiratory distress syndrome (ARDS). In 1967, Ashbaugh and colleagues first described some key features of ARDS, including: (a) respiratory distress and tachypnea (b) severe hypoxemia (c) diffuse alveolar infiltrates on chest radiography and (d) decreased lung compliance, all occurring in the setting of an acute medical or surgical illness. While this descriptive definition lacks specificity, it encompasses the fundamental concept that ALI is diffuse lung injury caused either by a direct (e.g., aspiration of gastric contents) or an indirect (e.g., sepsis) pulmonary insult.

In hopes of standardizing clinical care and research studies, attempts have been made to apply more strict criteria to the definition of ARDS. Murray and colleagues in 1988 proposed a comprehensive definition of ARDS, including details on: the severity of lung injury, the mechanism of lung injury, and the presence of non-pulmonary organ dysfunction. Lung injury was quantified based on the severity of 4 parameters and termed the Lung Injury Score (LIS); it includes: (a) the ratio of the partial pressure of arterial oxygen to the fraction of inspired oxygen (PaO2/FiO2), (b) the level of positive end-expiratory pressure (PEEP) applied during mechanical ventilation, (c) the static lung compliance, and (d) the extent of alveolar infiltrates on chest radiographs.

Type
Chapter
Information
Medical Management of the Surgical Patient
A Textbook of Perioperative Medicine
 , pp. 142 - 157
Publisher: Cambridge University Press
Print publication year: 2006

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