Lung-Cardiovascular Interactions and Derangements in ARDS

The acute respiratory distress syndrome (ARDS) is fundamentally characterized by alveolar injury, leading to lung edema, severe hypoxemia, and poorly compliant lungs. Alveolar and cardiovascular pathology are deeply intertwined in the syndrome, which can be marked by clinical cardiac, pulmonary, and systemic vascular abnormalities. Pulmonary vascular dysfunction is common even in the era of lung-protective ventilation, is associated with right ventricular (RV) dysfunction, and worse mortality. Frustratingly, these cardiovascular abnormalities pose management challenges for which we have limited targeted therapies that improve clinical outcomes. Recent inroads disentangling patient heterogeneity in ARDS may offer a direct avenue connecting biological mechanisms to effective treatments. Throughout this review, we will examine the clinical involvement of the cardiovascular system in ARDS, grounded on pathological and biological studies, and review available evidence for potential targeted therapies.