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Epidemiology of Acute Lung Injury and ARDS*

Leonard D. Hudson, MD, FCCP; Kenneth P. Steinberg, MD, FCCP
Author and Funding Information

*From the Department of Pulmonary and Critical Care Medicine (Drs. Hudson and Steinberg), Harborview Medical Center, University of Washington School of Medicine (Dr. Steinberg), Seattle, WA.

Correspondence to: Leonard D. Hudson, MD, FCCP, Harborview Medical Center, 325 Ninth Ave., Box 359762, Seattle, WA 98104-2499



Chest. 1999;116(suppl_1):74S-82S. doi:10.1378/chest.116.suppl_1.74S-a
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Extract

ARDS and acute lung injury (ALI) are terms used to reflect what we think is a relatively specific form of pathologic injury to the lung but occurring from a wide diversity of causes or associated conditions. The assumption underlying use of these terms is that the abnormality reflects diffuse alveolar damage, involving both the endothelial and epithelial layers. This damage is characterized pathophysiologically by a breakdown in the barrier and gas exchange functions in the lung. Initially this results in flooding of the alveolar spaces with protein-rich edema fluid resulting in severe gas exchange abnormalities. If the process is sustained, fibroproliferation occurs with collagen deposition and lung remodeling. Since pathology specimens are rarely available and no practical methods exist to measure the barrier function or endothelial and epithelial injuries, we are left with definitions using surrogates or clinical reflections of these processes. Thus, we have defined ARDS and ALI in terms of their associated gas exchange abnormalities and radiologic manifestations. The specific definitions used have enormous effects on the outcomes of epidemiologic studies. Therefore, whenever epidemiologic data are evaluated, the specific definitions used must be kept in mind.


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