Mechanisms of ARDS and acute lung injury

The exact mechanisms responsible for the development of ARDS depend on whether the stimulus is direct or indirect, but always involve complex interactions between cellular elements and inflammatory mediators as well as cascade effects ( e.L§L 1991). These mechanisms frequently lead to a 'snowballing' of the inflammatory reaction, with diffusion to other organs, often resulting in development of the multiple system organ failure syndrome. The precise nature of these mechanisms has not been fully elucidated for several reasons. First, animal models are at best imperfect reproductions of human ARDS. Second, clinical studies focus on the presence of mediators in plasma or bronchoalveolar lavage fluid. Lastly, investigation of the early phases of the syndrome is difficult in humans. Also, it is not understood why, for a given severity of clinical state, one patient develops complicated ARDS whereas another recovers uneventfully. Genetic factors, including a predisposition to increased synthesis of certain cytokines, are suspected in this clinical heterogeneity; early onset of decreased immune function may also explain these differences.

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