Acute respiratory distress syndrome: focusing on secondary injury

Abstract

Acute respiratory distress syndrome (ARDS) is one of the most common severe diseases seen in the clinical setting. With the continuous exploration of ARDS in recent decades, the understanding of ARDS has improved. ARDS is not a simple lung disease but a clinical syndrome with various etiologies and pathophysiological changes. However, in the intensive care unit, ARDS often occurs a few days after primary lung injury or after a few days of treatment for other severe extrapulmonary diseases. Under such conditions, ARDS often progresses rapidly to severe ARDS and is difficult to treat. The occurrence and development of ARDS in these circumstances are thus not related to primary lung injury; the real cause of ARDS may be the “second hit” caused by inappropriate treatment. In view of the limited effective treatments for ARDS, the strategic focus has shifted to identifying potential or high-risk ARDS patients during the early stages of the disease and implementing treatment strategies aimed at reducing ARDS and related organ failure. Future research should focus on the prevention of ARDS.

Assessment of Pulmonary Circulation of Critically Ill Patients Based on Critical Care Ultrasound

“…Acute respiratory distress syndrome (ARDS) is a common critical illness with high morbidity and mortality. During the development of various diseases such as sepsis, shock, trauma, and burns, the damage of pulmonary capillary endothelial cells and alveolar epithelial cells causes diffuse pulmonary interstitial and alveolar edema, leading to acute hypoxic respiratory insufficiency or respiratory failure [9,46]. ARDS not only causes lung injury but also damages pulmonary circulation.…”

“…In patients with ARDS, restrictive fluid management strategies can help improve oxygenation and reduce pulmonary circulation injury [46,[48][49][50]. ARDS patients are prone to acute cor pulmonale (ACP) when the plateau pressure and driving pressure are too high even with a lung protective ventilation strategy.…”

“…The systemic inflammatory response and excessive release of catecholamines caused by sepsis can lead to excessive degradation of the vascular endothelial glycocalyx, causing damage to vascular endothelial cells [62,63]. Destruction of pulmonary capillary endothelial cells leads to increased pulmonary capillary permeability, which in turn leads to pulmonary interstitial edema and gravity-dependent consolidation [46]. The signs of lung ultrasound can quickly assess the extent and degree of pulmonary microcirculatory damage [47].…”

PPV May Be a Starting Point to Achieve Circulatory Protective Mechanical Ventilation

“…Prone position ventilation is used to reduce pulmonary circulation resistance, improve ventilation and blood flow matching, and improve right heart function. Therefore, based on the above treatment to prevent secondary injury ( 35 ), what else can we do? A new understanding of PPV will help us to protect the circulation during mechanical ventilation.…”

Effects of beta-blockers use on mortality of patients with acute respiratory distress syndrome: a retrospective cohort study

“…ARDS differs from simple pulmonary diseases as it is a clinical syndrome with diverse potential etiologies and pathophysiological characteristics. Its development and occurrence are not necessarily linked to primary lung injury but may result from an unregulated host/organ response (HOUR), commonly referred to as the "second hit" (Pan et al, 2021;Huang et al, 2023). Effective management of acute respiratory distress syndrome entails evaluating the efficacy of therapeutic interventions and preventing secondary lung injury caused by this "second hit.…”