Acute lung injury and the acute respiratory distress syndrome

Although acute lung injury/acute respiratory distress syndrome mortality rates have improved over the last several decades, they remain high, particularly in the geriatric patient population. Although considerable progress has been made in understanding the pathogenesis of the disease, a large number of promising treatments have proved unsuccessful. One exception has been in the area of ventilator management, where a strategy of protective ventilation with low tidal volumes has demonstrated a significant mortality benefit. Basic research continues to help advance our understanding of this complex syndrome and identify interesting new directions of investigation. The results of several large, randomized trials of new ventilatory and pharmacologic strategies currently underway may help identify successful methods of treating this important disease.