Acute respiratory distress syndrome. Issue 10 (October 2022)

• Record Type: Journal Article
• Authors: Parikh aka Parmar, Tapan; Pilcher, David
• Is Part Of: Anaesthesia and intensive care medicine. Volume 23:Issue 10(2022)
• Page Start: 635
• Page End: 641
• Publication Date: 2022-10
• Subjects: Acute respiratory distress syndrome -- ARDS -- COVID-19 -- ECMO -- individualized ventilation -- intensive care -- lung-protective ventilation -- P-SILI -- pathophysiology -- rescue therapies; Anesthesiology -- Periodicals; Critical care medicine -- Periodicals; Anesthesia -- Periodicals; Intensive care -- Periodicals; Electronic journals; Periodicals; 617.9605
• DOI: 10.1016/j.mpaic.2022.07.010
• Languages: English
• ISSNs: 1472-0299

Abstract

Abstract: Acute respiratory distress syndrome (ARDS) is a heterogeneous lung disease that is triggered by pulmonary and non-pulmonary pathologies. It predominantly causes hypoxaemic respiratory failure and can lead to significant morbidity and mortality. Although ARDS remains underdiagnosed, 24% of mechanically ventilated patients in intensive care units and 33% of coronavirus disease (COVID-19) patients admitted to the hospital are reported to have ARDS. Despite recent advances in treatment, mortality remains at more than 30% for all ARDS patients and 43% for severe ARDS. The pathophysiology is complex and involves acute pulmonary and systemic inflammation, alveolar oedema, and de-recruitment which lead to ventilation-perfusion mismatch, reduced lung compliance and hypoxaemia. Similarities in the pathophysiology of COVID-19 ARDS outnumber differences from non-COVID-19 ARDS. Inhomogeneous distribution of transpulmonary pressure variation throughout the lungs in ARDS increases the risk of patient self-inflicted lung injury and ventilator-associated lung injury. Stratifying ARDS patients as per Berlin definition can help to recognize ARDS early, identify resource requirements and plan appropriate management. Treating the underlying cause, lung-protective ventilation and supportive care are the mainstays of clinical management. Multiple rescue therapies, novel treatments, and methods of facilitating individualized ventilation have been described but many require further validation; and appropriate patient selection is warranted.