Abstract
Acute respiratory distress syndrome (ARDS) is characterized by acute diffuse lung injury, which results in increased pulmonary vascular permeability and loss of aerated lung tissue. This causes bilateral opacity consistent with pulmonary edema, hypoxemia, increased venous admixture, and decreased lung compliance such that patients with ARDS need supportive care in the intensive care unit to maintain oxygenation and prevent adverse outcomes. Recently, advances in understanding the underlying pathophysiology of ARDS led to new approaches in managing these patients. In this review, we want to focus on recent scientific evidence in the field of ARDS research and discuss promising new developments in the treatment of this disease.
Highlights
Normal lung function requires dry alveoli situated closely to perfused capillaries to perform sufficient gas exchange
driving pressure (ΔP) was significantly associated with increased survival in a pooled retrospective analysis of randomized controlled trial (RCT) focusing on optimal positive end-expiratory pressure (PEEP) and V settings in acute respiratory distress syndrome (ARDS)
Despite some limitations (2,015 patients were not screened, differences in baseline characteristics, and excluding patients if PaO2/FiO2 was reduced by 20% while in prone position, and so on), the trial indicates the potential benefits of early long proning of patients with severe ARDS in experienced centers
Summary
Normal lung function requires dry alveoli situated closely to perfused capillaries to perform sufficient gas exchange. LTVV improves survival and other clinical outcome parameters by reducing alveolar over-distention[24,25] This beneficial effect is corroborated by a recent meta-analysis of four RCTs24 and a subanalysis of the LUNG SAFE (Large Observational Study to Understand the Global Impact of Severe Acute Respiratory Failure) trial in patients with moderate to severe ARDS showing that peak inspiratory pressure, besides other factors, is a modifiable risk factor for worse outcome[26]. The Lung Open Ventilation Study (LOVS) trial in 2008 showed improved oxygenation and less need of rescue strategies in the high PEEP group, but no difference in mortality was found[42]. Increased miR-125b levels resulted in an improvement of lung function in LPS-injured mice[96] Despite these findings, the prognostic value of circulating miRNAs in ARDS remains unexplored. Eculizumab may block C5-induced NET release in ARDS, leading to improved outcomes
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