Acute lung injury (ALI) and acute respiratory distress syndrome (ARDS) continue to be major causes of morbidity and mortality in the ICU due to a lack of specific, effective therapy. Affecting approximately 200,000 people every year in the Uni- ted States alone, patients with this syndrome often require extensive ICU and hospital care. This leads to enormous utilization of healthcare resources and significant expenditures, and ultimately leaves survivors with a reduced quality of life.
ALI/ARDS is a disease of altered capillary permeability characterized by significant fluid imbalances and oncotic pressure changes. Although investigations directed at these abnormalities may improve patient-centred outcomes, fluid management in ALI/ARDS continues to be a source of great controversy. In this article, we discuss fluid balance and the colloid osmotic pressure gradients in ALI/ARDS, followed by a review of the prognostic implications of increasing extravascular lung water. We conclude with contemporary approaches to optimizing therapy in this condition, including the role of albumin and diuretic therapy.
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