Early Identification and Diagnostic Approach in Acute Respiratory Distress Syndrome (ARDS)

Abstract

Acute respiratory distress syndrome (ARDS) is a life-threatening condition defined by the acute onset of severe hypoxemia with bilateral pulmonary infiltrates, in the absence of a predominant cardiac involvement. Whereas the current Berlin definition was proposed in 2012 and mainly focused on intubated patients under invasive mechanical ventilation, the recent COVID-19 pandemic has highlighted the need for a more comprehensive definition of ARDS including patients treated with noninvasive oxygenation strategies, especially high-flow nasal oxygen therapy, and fulfilling all other diagnostic criteria. Early identification of ARDS in patients breathing spontaneously may allow assessment of earlier initiation of pharmacological and non-pharmacological treatments. In the same way, accurate identification of the ARDS etiology is obviously of paramount importance for early initiation of adequate treatment. The precise underlying etiological diagnostic (bacterial, viral, fungal, immune, malignant, drug-induced, etc.) as well as the diagnostic approach have been understudied in the literature. To date, no clinical practice guidelines have recommended structured diagnostic work-up in ARDS patients. In addition to lung-protective ventilation with the aim of preventing worsening lung injury, specific treatment of the underlying cause has a central role to improve outcomes. In this review, we discuss early identification of ARDS in non-intubated patients breathing spontaneously and propose a structured diagnosis work-up.

Histopathologic and Immunohistochemical Assessment of Acute Respiratory Distress Syndrome (ARDS): Challenges and Complexities of Postmortem Diagnose

“…are also quite common in relation to ARDS/ALI. [17][18][19] Although there was no IHC result to support the findings, in our study, we observed that 31 cases presented some evidence of acute inflammatory processes in the lungs, of which 26 cases were associated with a bacterial infection.…”

“…Bacterial agents such as Pneumococci , Streptococcus , gram-negative bacilli, Legionella spp., leptospirosis, among others, and fungal agents such as Fusarium spp., Aspergillus spp., Blastomyces spp., Cryptococcus spp., and Histoplasma spp. are also quite common in relation to ARDS/ALI 17–19. Although there was no IHC result to support the findings, in our study, we observed that 31 cases presented some evidence of acute inflammatory processes in the lungs, of which 26 cases were associated with a bacterial infection.…”

Co-Infections and Superinfections in COVID-19 Critically Ill Patients Are Associated with CT Imaging Abnormalities and the Worst Outcomes

“…To be included in the study, all the patients had to receive a diagnosis of COVID-19-related ARDS and undergo at least one chest CT at our Institute. In particular, COVID-19 ARDS was diagnosed when a patient with confirmed COVID-19 infection developed acute respiratory distress meeting the Berlin 2012 ARDS diagnostic criteria, which include (a) acute hypoxemic respiratory failure (b) developing within 1 week of onset of symptoms (c) with bilateral air space opacities on X-ray or CT (d) not explained by cardiac failure or fluid overload [ 28 , 29 ]. Patients with COVID-19-related ARDS investigated only with other imaging techniques (X-ray or Ultrasound) and/or with CT performed outside our Institute were excluded.…”

An Imaging Overview of COVID-19 ARDS in ICU Patients and Its Complications: A Pictorial Review

“…COVID-19 ARDS is diagnosed when a patient with confirmed COVID-19 infection develops acute respiratory distress and meets the Berlin 2012 ARDS diagnostic criteria which include: (i) acute hypoxemic respiratory failure (ii) developing within 1 week of onset of symptoms (iii) with bilateral air space opacities on X-ray or CT (iv) not explained by cardiac failure or fluid overload [32,33].…”