Lung Edema Clearance: 20 Years of Progress: Invited Review: Active fluid clearance from the distal air spaces of the lung

1 University of California, San Francisco, California 94143-0624; 2 Department of Physiology, INSERM 4426; Faculté de Médecine, Xavier Bichat Université, Paris 7; and 3 EA3512, IFR02, Faculté Xavier Bichat, 75018 Paris, France Active ion transport drives iso-osmolar alveolar fluid clearance, a hypothesis originally suggested by in vivo studies in sheep 20 yr ago. Over the last two decades, remarkable progress has been made in establishing a critical role for active sodium transport as a primary mechanism that drives fluid clearance from the distal air spaces of the lung. The rate of fluid transport can be increased in most species, including the human lung, by cAMP stimulation. Catecholamine-independent mechanisms, including hormones, growth factors, and cytokines, can also upregulate epithelial fluid clearance in the lung. The new insights into the role of the distal lung epithelium in actively regulating lung fluid balance has important implications for the resolution of clinical pulmonary edema. pulmonary edema; lung fluid balance; acute lung injury; active ion transport; alveolar epithelium; pulmonary epithelium; -adrenergic agonists