Looking back over >40 yrs of research into acute lung injury (ALI) and the acute respiratory distress syndrome could leave one feeling bad about what has been achieved. None of our proposed interventions have proven to be beneficial, partly owing to problems associated with the syndrome's definition (1) and partly because large trials have been flawed in their design and inception (2). The one notable exception resulted in the demonstration that we had been very much part of the problem by creating ventilator-induced lung injury with resulting multiple organ failure and sadly also death by overventilating injured lungs (3).
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