Ravinder Khera | International Journal of Nursing Critical Care | Vol 11, Issue 01
Abstract
Acute Respiratory Distress Syndrome (ARDS) is a serious medical condition marked by significant low oxygen levels in the blood, bilateral lung infiltrates, and extensive lung inflammation. It is often caused by a range of direct or indirect injuries to the lungs. Despite considerable advances in understanding the pathophysiology of ARDS, its complex and multifactorial nature continues to challenge clinicians in both diagnosis and management. This review provides a comprehensive analysis of the pathogenesis of ARDS, focusing on the inflammatory cascade, endothelial and epithelial injury, and the disruption of the alveolar-capillary barrier. Grasping these mechanisms is essential for recognizing possible treatment targets and enhancing patient recovery. The diagnostic approach to ARDS involves the recognition of clinical features such as rapid onset of respiratory failure, refractory hypoxemia, and imaging findings that exclude other potential causes of respiratory distress. Developments in imaging technologies, like high-resolution CT scans, have greatly enhanced the accuracy of diagnoses. Furthermore, recent studies emphasize the role of biomarkers in the early detection and prognostication of ARDS. In terms of management, current strategies are largely focused on mechanical ventilation with low tidal volumes to minimize ventilator-induced lung injury. Adjunct therapies, such as prone positioning and extracorporeal membrane oxygenation (ECMO), have shown promise in improving oxygenation and reducing mortality rates in severe cases. Innovative treatment modalities, including anti-inflammatory agents, stem cell therapy, and surfactant replacement, are under investigation and may offer new hope for ARDS patients in the future. This review aims to provide an in-depth understanding of ARDS from its underlying pathogenesis to the evolving management strategies, offering insights into improving both the prevention and treatment of this life-threatening syndrome.
Keywords: Acute Respiratory Distress Syndrome, pathogenesis, mechanical ventilation, biomarkers, innovative therapies.
Keywords
Biomarkers, Acute Respiratory Distress Syndrome, mechanical ventilation, pathogenesis, innovative therapies.
References
1. ARDS Definition Task Force; Ranieri VM, Rubenfeld GD, Thompson BT, Ferguson ND, Caldwell E, Fan E, Camporota L, Slutsky AS. Acute respiratory distress syndrome: the Berlin Definition. JAMA. 2012 Jun 20;307(23):2526-33. doi: 10.1001/jama.2012.5669. PMID: 22797452. 2. Thompson BT, Chambers RC, Liu KD. Acute Respiratory Distress Syndrome. N Engl J Med. 2017 Aug 10;377(6):562-572. doi: 10.1056/NEJMra1608077. PMID: 28792873. 3. Guérin C, Reignier J, Richard JC, Beuret P, Gacouin A, Boulain T, Mercier E, Badet M, Mercat A, Baudin O, Clavel M, Chatellier D, Jaber S, Rosselli S, Mancebo J, Sirodot M, Hilbert G, Bengler C, Richecoeur J, Gainnier M, Bayle F, Bourdin G, Leray V, Girard R, Baboi L, Ayzac L; PROSEVA Study Group. Prone positioning in severe acute respiratory distress syndrome. N Engl J Med. 2013 Jun 6;368(23):2159-68. doi: 10.1056/NEJMoa1214103. Epub 2013 May 20. PMID: 23688302. 4. Tremblay LN, Slutsky AS. Ventilator-induced lung injury: from the bench to the bedside. Intensive Care Med. 2006 Jan;32(1):24-33. doi: 10.1007/s00134-005-2817-8. Epub 2005 Oct 18. PMID: 16231069. 5. Combes A, Hajage D, Capellier G, Demoule A, Lavoué S, Guervilly C, Da Silva D, Zafrani L, Tirot P, Veber B, Maury E, Levy B, Cohen Y, Richard C, Kalfon P, Bouadma L, Mehdaoui H, Beduneau G, Lebreton G, Brochard L, Ferguson ND, Fan E, Slutsky AS, Brodie D, Mercat A; EOLIA Trial Group, REVA, and ECMONet. Extracorporeal Membrane Oxygenation for Severe Acute Respiratory Distress Syndrome. N Engl J Med. 2018 May 24;378(21):1965-1975. doi: 10.1056/NEJMoa1800385. PMID: 29791822. 6. Mang S, Karagiannidis C, Lepper PM. Wenn maschinelle Beatmung nicht mehr ausreicht – venovenöse extrakorporale Membranoxygenierung [When mechanical ventilation fails-Venovenous extracorporeal membrane oxygenation]. Inn Med (Heidelb). 2023 Oct;64(10):922-931. German. doi: 10.1007/s00108-023-01586-y. Epub 2023 Sep 18. PMID: 37721597. 7. Combes A, Bréchot N, Luyt CE, Schmidt M. Indications for extracorporeal support: why do we need the results of the EOLIA trial? Med Klin Intensivmed Notfmed. 2018 Feb;113(Suppl 1):21-25. English. doi: 10.1007/s00063-017-0371-0. Epub 2017 Nov 17. PMID: 29149363. 8. Munshi L, Walkey A, Goligher E, Pham T, Uleryk EM, Fan E. Venovenous extracorporeal membrane oxygenation for acute respiratory distress syndrome: a systematic review and meta-analysis. Lancet Respir Med. 2019 Feb;7(2):163-172. doi: 10.1016/S2213-2600(18)30452-1. Epub 2019 Jan 11. PMID: 30642776. 9. Sauer CM, Yuh DD, Bonde P. Extracorporeal membrane oxygenation use has increased by 433% in adults in the United States from 2006 to 2011. ASAIO J. 2015 Jan-Feb;61(1):31-6. doi: 10.1097/MAT.0000000000000160. PMID: 25303799. 10. Grasselli G, Calfee CS, Camporota L, Poole D, Amato MBP, Antonelli M, Arabi YM, Baroncelli F, Beitler JR, Bellani G, Bellingan G, Blackwood B, Bos LDJ, Brochard L, Brodie D, Burns KEA, Combes A, D'Arrigo S, De Backer D, Demoule A, Einav S, Fan E, Ferguson ND, Frat JP, Gattinoni L, Guérin C, Herridge MS, Hodgson C, Hough CL, Jaber S, Juffermans NP, Karagiannidis C, Kesecioglu J, Kwizera A, Laffey JG, Mancebo J, Matthay MA, McAuley DF, Mercat A, Meyer NJ, Moss M, Munshi L, Myatra SN, Ng Gong M, Papazian L, Patel BK, Pellegrini M, Perner A, Pesenti A, Piquilloud L, Qiu H, Ranieri MV, Riviello E, Slutsky AS, Stapleton RD, Summers C, Thompson TB, Valente Barbas CS, Villar J, Ware LB, Weiss B, Zampieri FG, Azoulay E, Cecconi M; European Society of Intensive Care Medicine Taskforce on ARDS. ESICM guidelines on acute respiratory distress syndrome: definition, phenotyping and respiratory support strategies. Intensive Care Med. 2023 Jul;49(7):727-759. doi: 10.1007/s00134-023-07050-7. Epub 2023 Jun 16. PMID: 37326646; PMCID: PMC10354163.
