Abstract
Acute respiratory distress syndrome (ARDS) is associated with high morbidity and mortality, and current management has a dramatic impact on healthcare resource utilization. While our understanding of this disease has improved, the majority of treatment strategies remain supportive in nature and are associated with continued poor outcomes. There is a dramatic need for the development and breakthrough of new methods for the treatment of ARDS. Isolated machine lung perfusion is a promising surgical platform that has been associated with the rehabilitation of injured lungs and the induction of molecular and cellular changes in the lung, including upregulation of anti-inflammatory and regenerative pathways. Initially implemented in an ex vivo fashion to evaluate marginal donor lungs prior to transplantation, recent investigations of isolated lung perfusion have shifted in vivo and are focused on the management of ARDS. This review presents current tenants of ARDS management and isolated lung perfusion, with a focus on how ex vivo lung perfusion (EVLP) has paved the way for current investigations utilizing in vivo lung perfusion (IVLP) in the treatment of severe ARDS.
Highlights
Acute respiratory distress syndrome (ARDS) is associated with high morbidity and mortality, and current management has a dramatic impact on healthcare resource utilization
Acute respiratory distress syndrome (ARDS) is a severe, life-threatening form of acute lung injury characterized by inflammation, lung permeability, and edema [1,2,3]
A large recent interInnat.tJi.oMnoal. lScei.v2a02lu0,a2t1i,oxnFOoRfPAEERRDRSEViInEWthe critical care population demonstrated that 10.4% o2f oinf t1e4nsive care unit (ICU) patTieanbltes1a.nDdiag2n3o.4si%s ofoafciunteturebsaptireadtoIryCdUistpreastsiesynntdsrhomade: ABeRrliDn Scr[it1e,r8ia].[6I]n. -hospital mortality for the severe subgroup reached as high as 46.1% [1,8]
Summary
Acute respiratory distress syndrome (ARDS) is a severe, life-threatening form of acute lung injury characterized by inflammation, lung permeability, and edema [1,2,3]. In-hospital mortality for the severe subgroup reached as higThraausm4a6a.1n%d b[u1r,8n]I.nAjurryecent analysis of the national inpatient sample from 2006–2014 by Eworuke BeltoCoaadlr.dpdioreopmduulomcntosantdraamrtyiendbiystiprnaacstrisoenasing incidence of ARDS and a most recent rate of 193.4 casesIpscehre1m0i0a,-0re0p0eprfoupsiuolnatiniojunry[9f]o.lWlowhiilnegaludnogwtrnawnsaprldanttraetniodnin in-hospital mortality has been reported, it remained quite higChOoVvIeDr-1th9iisnfteicmtieonperiod, with rates for sepsis, shock, and pneumonia approximating 40% [9]. In those who physically recover, high risks of cognitive (e.g.,d[vIa1deyn0nes]tft.niuiblAtnaiitodficittodciionaictnstiaio,,onnmrdneauslIlusCyacs,nUuctdlihasteatratawymipo)eapnrane,rkasoanugpneelstdrmisina,segdtoneeiutnprotrcsrfeieegspascnaiotiotmfniniect,enaranontnsttldwefoocpiorftohnssotetAh-mptRersiaciDusui)Smmn[ia1pdst]aie.occrfBtsltyet[er1nyie1nos]rgs.nesddocisutaohrurcidssee,e-irtnhhoteeafnvcsueAivrbRreeeDe(nnpStrrmoeilpsoaonnrgeatseegsddeemnteinatl of ARDSIdisenlatirfgicealtyionsuapnpdoarptipvreopinrianteatturerea,tmweintthobfatshiec utenndaenrltysinigncclauudsienogf lAunRgDSprisoteescsteinvteiavl e(en.tgi.l,ation, consearnvtiabtiiovteicfls,uriedsumscaintaatgioenm, eanndt, nsoeuurrcoemcounstcruollafrorblsoecpksiasd) e[1, ]a.nBdeypornodnethpiso,stihtieocnuinrrgenfot rmsaenvaegreemdeisnetaosfe [1,4]. The continued emergence of pathogens causing severe ARDS, such as COVID-19, development and breakthrough of new treatment modalities is crucial [7]
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