Updated management of patients with acute lung injury and acute respiratory distress syndrome\

Acute lung injury (ALI) and its more severe form, the acute respiratory distress syndrome (ARDS) which is a catastrophic form of acute respiratory failure, characterized by non-hydrostatic pulmonary edema and severe hypoxemia which results from alveolar-capillary membrane damage caused by multiple factors. Different etiologies of ALI/ARDS include direct causes that involve lung as pneumonia and aspiration of gastric contents. and indirect causes as sepsis, severe trauma with shock, acute pancreatitis and drug overdose. Despite musch improvement in the understanding of pathophysiology of the disease and recent success in therapy, the mortality rate remains high at 35-40%.Clinical features of the disease can occur gradually or acutely in the form of tacchypnea, dyspnea, cough, cyanosis, coarse crackles on the chest and agitation. So, radiological and pathophysiological criteria are the cornerstone in diagnosis, staging and follow up of ALI/ARDS. Improved understanding of the pathogenesis of ALI/ARDS had led to important advances in the treatment particularly in the area of ventilator-associated lung injury including a protective ventilatory strategies. The aim of the work is to discuss the following issues regarding ALI/ARDS:Etiology and incidence, pathophysiology, clinical course diagnosis and supportive and pharmacological therapieutic options.With focusing spot light on mechanical ventilation with recent protective strategies and new recruitment maneuvers