Acute respiratory distress syndrome: causes, pathophysiology, and phenotypes

Area of Science:

• Pulmonology and Critical Care Medicine
• Pathophysiology
• Inflammation and Coagulation Research

Background:

• Acute respiratory distress syndrome (ARDS) is a severe clinical syndrome characterized by acute respiratory failure, diffuse lung inflammation, and edema.
• Its pathophysiology is intricate, involving dysregulated inflammatory and coagulation pathways, both locally in the lungs and systemically.
• Mechanical ventilation, while life-saving, can exacerbate lung injury and inflammation.

Purpose of the Study:

• To highlight the complex pathophysiology of ARDS.
• To emphasize the importance of recognizing clinical heterogeneity and phenotypes in ARDS.
• To advocate for a precision-medicine approach for better patient stratification and understanding.

Main Methods:

• Review of existing literature on ARDS pathophysiology, inflammation, and coagulation.
• Analysis of the role of mechanical ventilation in ARDS progression.
• Discussion of the emerging concept of ARDS phenotypes and their clinical relevance.

Main Results:

• ARDS pathophysiology involves a complex interplay of injury, inflammation, and coagulation pathways.
• Clinical, biological, physiological, and radiological heterogeneity is a key feature of ARDS.
• Phenotypic identification is crucial for understanding patient-specific mechanisms.

Conclusions:

• Understanding the complex and heterogeneous nature of ARDS is essential.
• A precision-medicine strategy focusing on distinct ARDS phenotypes is needed.
• This approach promises to enhance the understanding of pathophysiological mechanisms and guide tailored treatments.