Abstract
Acute respiratory distress syndrome (ARDS) is characterized by permeability pulmonary edema and refractory hypoxemia. Recently, the new definition of ARDS has been published, and this definition suggested severity-oriented respiratory treatment by introducing three levels of severity according to PaO2/FiO2 and positive end-expiratory pressure. Lung-protective ventilation is still the key of better outcome in ARDS. Through randomized trials, short-term use of neuromuscular blockade at initial stage of mechanical ventilation, prone ventilation in severe ARDS, and extracorporeal membrane oxygenation in ARDS with influenza pneumonia showed beneficial efficacy. However, ARDS mortality still remains high. Therefore, early recognition of ARDS modified risk factors and the avoidance of aggravating factors during the patient's hospital stay can help decrease its development. In addition, efficient antifibrotic strategies in late-stage ARDS should be developed to improve the outcome.
Highlights
Acute respiratory distress syndrome (ARDS) is a permeability pulmonary edema characterized by increased permeability of pulmonary capillary endothelial cells and alveolar epithelial cells, leading to hypoxemia that is refractory to usual oxygen therapy
The aim of this review is to provide an update on ARDS
Cyclic recruitment/de-recruitment only decreased when high positive end-expiratory pressure (PEEP) and prone positioning were applied together (4.1% ± 1.9% to 2.9% ± 0.9%, P = 0.003), especially in patients with high lung recruitability [35]. These results showed that prone ventilation decreases alveolar instability and hyperinflation observed at high PEEP in ARDS patients
Summary
Acute respiratory distress syndrome (ARDS) is a permeability pulmonary edema characterized by increased permeability of pulmonary capillary endothelial cells and alveolar epithelial cells, leading to hypoxemia that is refractory to usual oxygen therapy. In two recent prospective observational studies, cor pulmonale occurrence was not negligible (up to one fourth) in ARDS patients ventilated with airway pressure limitations, was associated with sepsis, and was a risk factor for 28-day mortality [13,14] Considering these findings together with the association of high PEEP levels and elevated plateau pressure with pulmonary artery pressure [15], careful monitoring of acute cor pulmonale is recommended in ARDS. In adults with moderate-to-severe ARDS, early application of HFOV compared with an employment of a ventilation strategy of low tidal volume and high positive endexpiratory pressure, does not reduce, and may increase, in-hospital mortality [39]. In survivors of acute lung injury, there was no difference in physical function, survival, or multiple secondary outcomes at 6 and 12 months follow-up after initial trophic or full enteral feeding [51]
Sign-in/Register to view highlights & summary Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
