Acute Respiratory Distress Syndrome

Abstract

Objective:Acute respiratory distress syndrome (ARDS) is a devastating clinical syndrome whose diagnosis and therapy are still in question. The aim of this review was to discuss the current challenge for the diagnosis and treatment of ARDS.Data Sources:Data sources were the published articles in English through December 2017 in PubMed using the following key words: “acute respiratory distress syndrome,” “definition”, “diagnosis,” “therapy,” “lung protective strategy,” “right ventricular dysfunction,” and “molecular mechanism.”Study Selection:The selection of studies focused on both preclinical studies and clinical studies of therapy of ARDS.Results:The incidence of ARDS is still high, and ARDS causes high intensive care units admissions and high mortality. The Berlin Definition proposed in 2012 is still controversial owing to lack of sensitivity and specificity. ARDS is still under recognition and it is associated with high mortality. Lung protective strategies with low tidal volume (VT) and lung recruitment should consider the physiology of ARDS because ARDS presents lung inhomogeneity; the same low VT might increase local stress and strain in some patients with low compliance, and lung recruitment could injure lungs in ARDS patients with low recruitability and hemodynamic instability. Acute cor pulmonale is common in severe ARDS. ARDS itself and some treatments could worsen acute cor pulmonale. Molecular understanding of the pathogenic contributors to ARDS has improved, but the molecular-associated treatments are still under development.Conclusions:ARDS is a devastating clinical syndrome whose incidence and mortality has remained high over the past 50 years. Its definition and treatments are still confronted with challenges, and early recognition and intervention are crucial for improving the outcomes of ARDS. More clinical studies are needed to improve early diagnosis and appropriate therapy.

TLR4/NF-κB signaling pathway gene single nucleotide polymorphisms alter gene expression levels and affect ARDS occurrence and prognosis outcomes

“…It is also the final stage of acute lung injury, with a high mortality rate. [1,2] According to previous research, the incidence of ARDS in China is high, with an annual mortality rate of 52%. [3]…”

Down-regulation of miR-155 inhibits inflammatory response in human pulmonary microvascular endothelial cells infected with influenza A virus by targeting sphingosine-1-phosphate receptor 1

“…However, effective therapy is still lacking, and this leads to a high mortality rate (over 40%). [ 5 ] Given the morbidity and mortality of the last influenza outbreak and the potential for novel strain influenza to cause pandemic spread, the development of new therapeutics to ameliorate influenza-induced ARDS is urgently needed. In this study, it was demonstrated that the influenza A virus promoted the increased expression of miR-155 in HPMECs.…”

“…[ 1 , 2 ] A mild influenza A viral infection causes self-limited upper respiratory tract disease, and in severe cases, the disease can progress to acute respiratory distress syndrome (ARDS), which can be fatal. [ 3 – 5 ] Although the molecular mechanism is not fully known, accumulating evidence suggests that aberrant proinflammatory cytokine production, also known as a cytokine storm, is a key contributor to the development of severe disease caused by influenza A. [ 6 , 7 ] Conversely, modulation of the influenza A virus-mediated inflammatory response may represent a valid therapeutic strategy.…”

Few Facts: A Premature Baby and Common Problems

“…Acute respiratory distress syndrome (ARDS) is a devastating clinical syndrome whose diagnosis and therapy are still in question [6]. Acute respiratory distress syndrome (ARDS) is a life-threatening form of respiratory failure that affects approximately 200 000 patients each year in the United States, resulting in nearly 75,000 deaths annually.…”