Acute respiratory distress syndrome, the critical care paradigm: what we learned and what we forgotGattinoni, Luciano; Carlesso, Eleonora; Valenza, Franco; Chiumello, Davide; Caspani, Maria LuisaSection Editor(s): Vincent, Jean-Louis Editor Current Opinion in Critical Care: August 2004 - Volume 10 - Issue 4 - p 272-278 doi: 10.1097/01.ccx.0000135511.75998.22 Anniversary issue Buy Abstract Author InformationAuthors Article MetricsMetrics In the last several years, we definitely learned that the acute respiratory distress syndrome lung is small, nonhomogeneous, and that mechanical ventilation in this baby lung may cause physical damage as well as inflammatory reaction. The clinical benefit of the gentle lung treatment, based on a decrease of global/regional stress and strain into the lung, has been finally proved. However, we forgot the importance of lung perfusion and its distribution in this syndrome and, besides a low tidal volume, we still do not know how to handle the other variables of mechanical ventilation. Measurements of variables as transpulmonary pressure and end expiratory lung volume, for a rational setting of mechanical ventilation, should be introduced in routine clinical practice. Istituto di Anestesia e Rianimazione, Universita’ degli Studi di Milano, Ospedale Policlinico IRCCS, Milano, Italy Correspondence to Prof. Luciano Gattinoni, Istituto di Anestesia e Rianimazione, Ospedale Maggiore Policlinico-IRCCS, Via Francesco Sforza, 35 20122 Milano, Italy Tel: 39 02 55033232/3231; fax: 39 02 55033230; e-mail: email@example.com © 2004 Lippincott Williams & Wilkins, Inc.