Updates in the management of acute lung injury: a focus on the overlap between AKI and ARDS

Abstract

Acute respiratory distress syndrome (ARDS) is a major cause of hypoxemic respiratory failure in adults and can result from several predisposing factors, such as sepsis and trauma, which also predispose patients to acute kidney injury (AKI). Animal models of AKI and ARDS suggest that AKI increases inflammatory cytokines in the circulation such that IL-6 may be a direct mediator of AKI induced lung injury. When ARDS and AKI overlap, intensive care unit length of stay, resource utilization, and mortality increase dramatically. New evidence suggests that the prevalence and clinical implications of even mild AKI in patients with ARDS is likely underestimated. The cornerstone of therapy for ARDS continues to be low tidal volume ventilation, and more recent trials illustrate that diuretic administration to shock-free ARDS patients may help them avoid the deleterious effects of volume overload. This review focuses on new developments in the care of ARDS patients with a specific focus on interactions between the lungs and kidneys in patients with overlapping ARDS and AKI.