Therapeutic strategies for acute hypoxemic respiratory failure.

Acute hypoxemic respiratory failure is a pulmonary capillary leak state that occurs in many different clinical settings. The resultant edema causes refractory hypoxemia due to intrapulmonary shunting and loss of lung compliance. Mechanical ventilation with PEEP and high concentrations of supplemental oxygen are frequently necessary for patient survival, but these therapies may themselves contribute to further lung damage. Studies have shown that manipulations of the pulmonary circulation aimed at reducing the forces promoting edemagenesis have salutary effects on gas exchange and lung mechanics and can be performed safely. The use of these combined modalities for pediatric patient care has been discussed. Finally, other approaches to treatment currently being investigated in animal models of AHRF have been presented. As these and other new treatment methods are explored, hopefully it will be possible to decrease the unacceptably high mortality rate still encountered in AHRF.