Mechanisms of repair and remodeling following acute lung injury

At present, we largely lack the ability to correlate the clinical course of patients with acute respiratory distress syndrome (ARDS) with potential factors involved in the biochemical and cellular basis of lung repair. This requires very large patient databases with measurement of many biochemical parameters. Important mechanistic determinants during the repair phase can be sought by correlation with late outcomes, but a large-scale cooperative effort among multiple centers with sharing of follow-up data and patient specimens is essential. We also lack detailed human histologic material from many phases of ARDS, particularly the long-term morphologic impact on survivors. Establishment of a national registry that follows ARDS survivors and that would seek their cooperation in advance in obtaining autopsy specimens when they die would be very valuable. Correlating the pathology with their pulmonary function during recovery would give important insights into reasons for the different patterns of abnormal pulmonary functions.