The utility of clinical predictors of acute lung injury: towards prevention and earlier recognition.
The utility of clinical predictors of acute lung injury: towards prevention and earlier recognition.
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DOI：
10.1586/ers.10.78
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发表时间：
2010-12-01
影响因子：
3.9
通讯作者：
Matthay, Michael A
中科院分区：
文献类型：
--
作者：
Levitt, Joseph E;Matthay, Michael A
尽管我们对急性肺损伤病理生理学的理解取得了重大进展，但机械通气的肺保护策略仍然是唯一具有已证实的生存优势的治疗方法。许多药物疗法未能在多中心临床试验中显示出益处。脓毒症早期目标导向治疗的范例表明，在需要机械通气的呼吸衰竭发生之前开始治疗可能会带来更大的临床益处。因此，人们对更准确、更完整地描述高危患者群体的特征以及在需要机械通气之前识别急性肺损伤早期患者的兴趣越来越浓厚。本文讨论了越来越多的关于急性肺损伤临床预测因素（包括特定亚组的危险因素）的文献，重点关注与输血相关的危险因素，以及针对早期识别高危患者和呼吸衰竭发作前早期急性肺损伤患者的最新研究。
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.