About this Research Topic

Background

Acute lung injury (ALI) remains a serious medical problem and a holistic approach, investigating the physiologic, mechanical, inflammatory, and resuscitative impact on patient outcome is needed, if we are to reduce morbidity and mortality. The mortality of the acute respiratory distress syndrome (ARDS) remains unacceptably high without effective pharmacologic treatments. This has become striking apparent during the COVID-19 induced ARDS (CARDS) pandemic, with the leading cause of death being respiratory failure. Currently, once CARDS is established the only effective treatments are supportive in the form of protective mechanical ventilation (MV) and proning. However, if MV is set inappropriately it can cause and unintentional secondary ventilator induced lung injury (VILI), significantly increasing mortality. This Special Issue will contain original research and review manuscripts addressing all of the above components essential in the treatment of patients with ALI/ARDS. Original research papers can be on any topic related to ALI/ARDS pathophysiology and/or treatment, including but not restricted to: noninvasive respiratory support, protective mechanical ventilation, fluid and pressor management, pharmacologic treatments, hemoperfusion, or Extra Corporal Membrane Oxygenation (ECMO). Review papers should discuss the basic pathophysiologic mechanisms of their topic, building to a discussion on how this information may eventually translate into the clinic. The goal of this Research Topic is to present new research evidence and review the current basic science associated with multiple pathophysiologic mechanisms in all organ systems that impact ALI/ARDS and translate this knowledge to the bedside. This Research Topic will contain the physiologic mechanisms and potential treatment strategies that the clinician can use to improve care of the patient with or at high risk of developing ALI/ARDS.

Acute lung injury (ALI) remains a serious medical problem and mortality remains unacceptably high. One reason for the high mortality is the complex multiorgan pathophysiology associated with ALI and it’s most serious manifestation, ARDS. The most common causes of ARDS are pneumonia (primary) and sepsis (secondary) but development of ALI/ARDS is all associated with hemorrhagic shock, large transfusion volumes, burns, smoke inhalation, aspiration and trauma. Since the above injuries effect all organ systems they may also cause multiple organ dysfunction syndrome (MODS) in addition to ARDS, and thus a holistic approach to treatment must be taken. We postulate that a treatment cocktail of optimal resuscitative, pharmacologic, mechanical ventilation, renal replacement therapy, Hemoperfusion, and ECMO are necessary to significantly reduce ALI/ARDS-related mortality.

The scope of this Research Topic is broad and requests both original research and review papers dealing with the pathophysiology and treatment of ALI/ARDS caused by any mechanism (i.e. pneumonia, sepsis, trauma, burns, hemorrhagic shock, aspiration, smoke inhalation, etc). Treatment categories are also broad and can include pharmacologic, resuscitative, mechanical ventilation, renal replacement therapy, hemoperfusion, ECMO and heart-lung interactions. The goal of this Research Topic is to have multiple original and review papers dealing with all of the infectious and injury mechanisms that cause ALI/ARDS and all of the current state-of-the-art and novel treatment strategies. This Research Topic will serve as a summation of our current knowledge on ALI/ARDS pathophysiologic mechanisms and potential treatment strategies. A combination therapy for ALI/ARDS will be suggested based on the publications in this Research Topic.

Topic Editor Gary F. Nieman receives Unconditional educational grant from Drager Medical. The other Topic Editors declare no competing interests with regard to the Research Topic subject.

Keywords: heart-lung interactions, Renal Replacement therapy, ECMO, Hemoperfusion, Acute lung injury (ALI), Acute respiratory distress syndrome (ARDS), Ventilator Induced lung Injury (VILI), Mechanical ventilation, Lung mechanics, Fluid resuscitation, Pharmacologic treatments, Atelectrauma, Volutrauma, Biotrauma

Important note: All contributions to this Research Topic must be within the scope of the section and journal to which they are submitted, as defined in their mission statements. Frontiers reserves the right to guide an out-of-scope manuscript to a more suitable section or journal at any stage of peer review.

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