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Acute respiratory distress syndrome, the critical care paradigm: what we learned and what we forgot

Gattinoni, Luciano; Carlesso, Eleonora; Valenza, Franco; Chiumello, Davide; Caspani, Maria Luisa

Section 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

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:

© 2004 Lippincott Williams & Wilkins, Inc.