[Acute respiratory distress syndrome]

Area of Science:

• Critical Care Medicine
• Pulmonology
• Respiratory Physiology

Background:

• Acute respiratory distress syndrome (ARDS) is a severe lung injury characterized by inflammatory edema and hypoxemia.
• It results from increased lung capillary permeability, leading to alveolar flooding and intrapulmonary shunting.
• ARDS is often triggered by pneumonia, sepsis, trauma, or aspiration, presenting with characteristic pulmonary infiltrates.

Purpose of the Study:

• To review the pathophysiology, diagnosis, and management of Acute Respiratory Distress Syndrome (ARDS).
• To highlight key therapeutic strategies including mechanical ventilation, prone positioning, and fluid management.
• To discuss adjunctive therapies for severe hypoxemia in ARDS.

Main Methods:

• Review of existing literature on ARDS pathophysiology and treatment.
• Analysis of mechanical ventilation strategies, focusing on protective ventilation and PEEP.
• Evaluation of emerging therapies such as prone positioning and extracorporeal membrane oxygenation (ECMO).

Main Results:

• Protective ventilation (tidal volume 6 ml/kg IBW, plateau pressure <30 cm H2O) is associated with decreased mortality.
• Moderate-to-high PEEP levels are often needed for hypoxemia, but optimal titration remains unclear.
• Early prone positioning in patients with PaO2/FIO2 ≤150 has been linked to increased survival.

Conclusions:

• ARDS management requires addressing the underlying cause and employing lung-protective mechanical ventilation.
• Adjunctive therapies like prone positioning and ECMO may be necessary for severe cases.
• Fluid restriction and careful ventilator management are crucial for improving outcomes in ARDS.