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Surfactant Depletion Combined with Injurious Ventilation Results in a Reproducible Model of the Acute Respiratory Distress Syndrome ARDS
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Current Concepts of ARDS: A Narrative Review.

Michele Umbrello1, Paolo Formenti2, Luca Bolgiaghi3

  • 1Unità Operativa Complessa di Anestesia e Rianimazione, Ospedale San Paolo-Azienda Socio Sanitaria Territoriale Santi Paolo e Carlo, 20124 Milano, Italy. michele.umbrello@fastwebnet.it.

International Journal of Molecular Sciences
|December 31, 2016
PubMed
Summary

Acute respiratory distress syndrome (ARDS) is a severe lung condition. This review covers ARDS diagnosis, pathophysiology, and treatments like lung protective ventilation and prone positioning to improve outcomes.

Keywords:
acute respiratory distress syndromecritically ill patientslung-protective ventilationpositive end-expiratory pressure

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Area of Science:

  • Critical Care Medicine
  • Pulmonology
  • Respiratory Physiology

Background:

  • Acute respiratory distress syndrome (ARDS) presents with non-cardiogenic pulmonary edema, bilateral infiltrates, and reduced respiratory compliance.
  • Refractory hypoxemia is a defining characteristic of ARDS.
  • Recent redefinitions of ARDS still rely on clinical characteristics.

Purpose of the Study:

  • To review the diagnostic workup and pathophysiology of ARDS.
  • To present current and emerging therapeutic strategies for ARDS management.
  • To emphasize a holistic approach to respiratory and hemodynamic support in ARDS patients.

Main Methods:

  • Literature review of diagnostic criteria and pathophysiology of ARDS.
  • Synthesis of evidence on various therapeutic interventions for ARDS.
  • Discussion of mechanical ventilation strategies, including lung protective ventilation and monitoring parameters.

Main Results:

  • ARDS diagnosis relies on clinical presentation, including pulmonary edema and hypoxemia.
  • Therapeutic approaches include lung protective ventilation, prone positioning, neuromuscular blockade, inhaled vasodilators, corticosteroids, and recruitment maneuvers.
  • Minimizing ventilator-induced lung injury (VILI) through lung recruitment and avoiding lung overstress (monitoring transpulmonary pressure or driving pressure) is crucial.

Conclusions:

  • A comprehensive framework integrating respiratory and hemodynamic support is essential for ARDS management.
  • Strategies like lung protective ventilation, prone positioning, and potentially extracorporeal life support are vital for severe ARDS.
  • Monitoring lung recruitability and pressures is key to optimizing gas exchange and preventing VILI.