Case history: traumatic adult respiratory distress syndrome--a multisystem approach.

In spite of advances in the care of traumatically injured patients, management of adult respiratory distress syndrome has continued to challenge clinicians since it was first described. Recently the alveolar macrophage, which elaborates proinflammatory mediators, has been implicated in the pathogenesis of acute lung injury and eventually in a clinical picture of adult respiratory distress syndrome. This case history presents the use of experimental methods of treatment, including chemical mediator inhibitors, continuous arteriovenous hemofiltration, and pressure-controlled inverse ratio ventilation.