The utility of clinical predictors of acute lung injury: towards prevention and earlier recognition

Abstract

Despite significant advances in our understanding of the pathophysiology of acute lung injury, a lung-protective strategy of mechanical ventilation remains the only therapy with a proven survival advantage. Numerous pharmacologic therapies have failed to show benefit in multicenter clinical trials. The paradigm of early, goal-directed therapy of sepsis suggests greater clinical benefit may derive from initiating therapy prior to the onset of respiratory failure that requires mechanical ventilation. Thus, there is heightened interest in more accurate and complete characterization of high-risk patient populations and identification of patients in the early stage of acute lung injury, prior to the need for mechanical ventilation. This article discusses the growing literature on clinical predictors of acute lung injury (including risk factors for specific subgroups) with an emphasis on transfusion-related risk factors and recent research targeting the early identification of high-risk patients and those with early acute lung injury prior to the onset of respiratory failure.

Keywords::

• acute lung injury
• acute respiratory distress syndrome
• mechanical ventilation
• noninvasive ventilation
• pulmonary edema
• risk factors
• surgery
• transfusion-related lung injury
• trauma

Financial & competing interests disclosure

Joseph E Levitt is funded by an NIH/NHLBI K23 grant (1K23HL091334-01A2) to study the early identification of acute lung injury. Michael A Matthay is the sponsor for Joseph E Levitt’s K23 grant (1K23HL091334-01A2). The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

No writing assistance was utilized in the production of this manuscript.