Editorial Views  |   November 2016
Early Regional Inflammation: The Seeds of Lung Injury
Author Notes
  • From the Departments of Anesthesiology and Critical Care (M.C.) and Radiology (Y.X.), University of Pennsylvania, Philadelphia, Pennsylvania.
  • Corresponding article on page 992.
    Corresponding article on page 992.×
  • Accepted for publication July 28, 2016.
    Accepted for publication July 28, 2016.×
  • Address correspondence to Dr. Cereda: maurizio.cereda@uphs.upenn.edu
Article Information
Editorial Views / Respiratory System
Editorial Views   |   November 2016
Early Regional Inflammation: The Seeds of Lung Injury
Anesthesiology 11 2016, Vol.125, 838-840. doi:10.1097/ALN.0000000000001335
Anesthesiology 11 2016, Vol.125, 838-840. doi:10.1097/ALN.0000000000001335
CLINICIANS diagnose acute respiratory distress syndrome (ARDS) using consensus criteria such as the Berlin definition,1  which primarily rely on blood oxygen levels and on chest radiography to identify inflammatory lung injury. Patients who meet these criteria may benefit from low-stretch ventilation,2  prone positioning,3  muscle paralysis,4  and perhaps lung recruitment.5  Because ARDS is often underdiagnosed,6  improving its recognition and the application of evidence-based treatment should improve outcomes. Investigators, encouraged by funding agencies, are conducting research on early preemptive strategies capable of reducing ARDS incidence.7  However, there is no accepted standard for ARDS: autopsy studies show that consensus definitions have limited specificity (around 50%) when tested against histologically proven injury.8,9  This is obviously problematic when the goal is to contain lung inflammation: early therapy will have uncertain success until better markers of injury progression are available. Clinically diagnosed ARDS is the epilog of inflammatory dissemination, which sometimes starts in localized lung regions.10  We know little about this evolution. But the imaging study by Wellman et al.11  published in this issue of Anesthesiology provides some insight into the early stages of lung injury.
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