This issue of Critical Care Nursing Quarterly is the second of two issues to address specific acute pulmonary disease states from the perspective of advanced practice nursing management in collaboration with medical practice. The first issue published July-September 2004 (Volume 27/Number 3), addressed acute asthma, nosocomial pneumonia, community-acquired pneumonia, and mechanical ventilation. This issue focuses on respiratory failure, pulmonary embolism, acute respiratory distress syndrome, and acute exacerbations of chronic obstructive pulmonary disease (COPD). This second part in the collection of topics continues to examine life-threatening stages of acute pulmonary diseases frequently seen in the acute and critical care settings. Included in all articles is the most current knowledge regarding the condition and the very latest research-based approaches to therapies aimed at reducing morbidity and mortality among patients.

The article on respiratory failure by Markou, Myrianthefs, and Baltopoulos is a thorough review article that is meant to serve as an in-depth reference for practitioners. It describes possible causes and mechanisms leading to respiratory failure, reviews physiologic and clinical consequences of gas exchange abnormalities, and discusses clinical evaluation of patients. Treatment options for both acute and chronic respiratory failure are also outlined. The authors have also provided numerous tables that serve as a ready review that would help optimize patient care.

Mortality from pulmonary embolism remains high; however signs and symptoms are often subtle and nonspecific, making pulmonary embolism difficult to diagnose. Cardin and Marinelli provide a thorough review article of venous thromboembolic disease, focusing on clinical signs/symptoms, risk factors, treatment, and prevention.

Chronic obstructive pulmonary disease remains the fourth leading cause of death in the United States. Despite these statistics, COPD is often not diagnosed until late in the disease. Nurses and nurse practitioners should be familiar with evidence-based guidelines to manage COPD across the spectrum of disease severity. Gronkiewicz and Borkgren-Okonek review the pathophysiology of COPD and focus on clinical assessment and management of patients with an acute exacerbation. Thorough discussion of interventions, including pharmacotherapeutics, provides an excellent update for practitioners. Comorbid diseases such as malnutrition and depression, which are often not diagnosed or treated, are discussed in relation to their effects on the primary disease process. Guideline recommendations for long-term management and prevention of further exacerbations are then discussed.

Kane and Galanes review the pathophysiology and management of patients with acute lung injury and the acute respiratory distress syndrome, differentiating the two conditions by definition of severity. Although extensive research has been done over the past 30 years, there is little progress in reducing mortality from ARDS. Healthcare providers caring for these critically ill patients should be familiar with most current recommendations for mechanical ventilation, which are discussed in this review. These new ventilatory techniques provide hope for reductions in mortality and morbidity in this severe systemic disease. Supportive measures, including prevention of nosocomial infections are outlined. Lastly, ongoing research related to acute lung injury or acute respiratory distress syndrome is reviewed to provide readers with current information on developing therapies.

Our goal in coordinating this issue and the previous one is to provide the most current knowledge regarding the acute respiratory topics covered. Although clinicians at the bedside have little time for reviewing current research literature, they are, in fact, the individuals who are first-line providers and require constant updates delivered in concise, thorough literature reviews. Each of the authors in this two-part series has provided an extensive review of the literature on the topic and developed an integrated discussion of these findings. These articles should serve as comprehensive references for the acute and critical care practitioner. Specifically, the role of the nurse in acute care settings should clearly be prominent and may serve to guide and confirm current practice in the acute phases of treatment for these life-threatening pulmonary diseases.