Abstract
As management strategies for acute lung injury (ALI) are shown to have a significant impact on outcome, it is important to understand the biology, epidemiology, and clinical presentation of that injury. Although no effective pharmacologic interventions have reached the clinic, use of a low-ventilation strategy is of clear benefit. Surfactant replacement continues to be a topic of study, while use of nitric oxide, prone positioning, extracorporeal gas exchange, and high-frequency oscillatory ventilation have not been shown, in prospective randomized studies, to provide added benefit. Measures such as rigorous control of blood glucose levels and glucocorticoid replacement have a well-established role in certain settings. There are many challenges for clinical studies of ALI, including precise definition of target study populations and surrogate endpoints, adequate blinding, and standardization of supportive care measures.