Acute respiratory distress syndrome

Abstract

The acute respiratory distress syndrome (ARDS) is a common cause of respiratory failure in critically ill patients and is defined by the acute onset of noncardiogenic pulmonary edema, hypoxemia, and the need for mechanical ventilation. ARDS occurs most often in the setting of pneumonia, sepsis, aspiration of gastric contents or severe trauma, and is present in ~10% of all intensive care unit patients worldwide. Despite some improvements over the past decades, mortality remains high at 30–40% in most studies. Pathologic specimens from patients with ARDS most frequently reveal diffuse alveolar damage, and laboratory studies have demonstrated both alveolar epithelial and lung endothelial injury, resulting in accumulation of protein-rich inflammatory edema fluid in the alveolar space. Diagnosis is based on consensus syndromic criteria, with recent proposed modifications for under-resourced settings and for pediatric patients. Patient management focuses on implementing a lung-protective ventilation strategy; no specific pharmacotherapies have been identified. Long-term outcomes of patients with ARDS are increasingly recognized as important research targets, as many patients survive ARDS only to suffer ongoing functional and/or psychologic sequelae. Future directions include efforts to facilitate earlier recognition of ARDS, prognostic and/or predictive enrichment in clinical studies to identify responsive subsets, and ongoing efforts to understand fundamental mechanisms of lung injury that may respond to specific treatments.

Use of Corticosteroids in Coronavirus Disease 2019 Pneumonia: A Systematic Review of the Literature

“…Among those infected with COVID-19 some develop mild symptoms, however, a significant proportion progress to severe ARDS and thus require intensive care (26). The use of corticosteroids in patients presenting with ARDS of different etiologies remains controversial owing to mixed results in the existing literature, mainly derived from observational studies (27). Globally, high-dose glucocorticoids is among the most frequently used adjuncts in ARDS (17.9%) (28).…”

A “One-Health” approach for diagnosis and molecular characterization of SARS-CoV-2 in Italy

“…Patients with severe cases usually develop pneumonia or acute respiratory distress syndrome (ARDS), a condition that may require mechanical ventilation and intensive care unit treatment [3]. ARDS is often fatal [4]. The novel epidemic, recognized as a public health emergency of international concern on January 30 2020, and acknowledged at a pandemic on March 11 2020, was initially recognized in December 2019 in Wuhan City, Hubei Province, China, and continues to [5].…”

Dapsone as treatment adjunct in ARDS

“…Acute respiratory distress syndrome (ARDS) continues to have a high lethality. 1 This short note recounts past data showing that interleukin-8 (IL-8) attracts neutrophils, IL-8 increases in ARDS, and this IL-8 brings neutrophils to the lung. Those neutrophils degranulate and contribute to alveolar damage characteristic of ARDS regardless of the initial event triggering ARDS.…”

“…ARDS is a severe form of acute lung injury characterized by acute diffuse bilateral pulmonary infiltration of neutrophils, monocytes and lymphocytes, diminished lung compliance, alveolar destruction, and bronchoalveolar lumen hyaline deposition, all leading to hypoxemic respiratory failure. 1,2 Though there are many triggers or precipitating events leading to ARDS, f. ex. crush injury, pneumonia of any origin including Corona virus, and sepsis, the resulting pathophysiology is to some degree stereotyped.…”