Understanding the pathogenesis of ARDS is essential both to choosing effective management strategies and to looking for novel treatments. We have seen that mechanical ventilation can induce inflammation if applied inappropriately or reduce mortality if correctly used, and that this has a clear pathophysiological rationale. Similar concepts have led to ongoing studies of prone ventilation and to the investigation of other ventilatory strategies such as high frequency ventilation and lung rest with extracorporeal membrane oxygenation.

This chapter has outlined the key mediators involved in both the inflammatory and fibroproliferative responses and highlighted some of the important mechanisms through which these responses are regulated. Many of these mediators will be examined in more detail in other chapters in this book that deal with treatment options.

Funded by the Medical Research Council (MRC) UK.

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