A Comprehensive Review of the Management of Acute Respiratory Distress Syndrome

Abstract

Acute respiratory distress syndrome (ARDS) is an inflammatory process in the lungs that induces nonhydrostatic protein-rich pulmonary edema. ARDS occurs in roughly half of coronavirus disease 2019 (COVID-19) pneumonia patients, with most of them requiring intensive care. Oxygen saturation, partial pressure of the oxygen, and the fraction of the inspired oxygen are health indicators that may indicate a severe illness necessitating further investigation. As treatments have evolved, a typical pattern of ARDS has likewise evolved. In cases where mechanical ventilation is required, the use of low tidal volumes (<6 ml/kg ideal body weight) and airway pressures (plateau pressure <30 cmH 2 O) was recommended. For patients with moderate/severe ARDS (partial pressure to fractional inspired oxygen ratio <20), prone positioning was recommended for at least 16 hours per day. By contrast, high-frequency oscillation was not recommended. The use of inhaled vasodilators was recommended in patients with persistent hypoxemia despite invasive ventilation and prone position until extracorporeal membrane oxygenation (ECMO). The use of a conservative fluid management strategy was suggested for all patients. Mechanical ventilation with high positive end-expiratory pressure (PEEP) was suggested for patients with ARDS with a ratio of arterial oxygen partial pressure to fractional inspired oxygen (PF) ratios. ECMO was suggested as an adjunct to protective mechanical ventilation for patients with severe ARDS. In the absence of adequate evidence, research recommendations were made for corticosteroids and extracorporeal carbon dioxide removal. While decades of research have been conducted, treatment options for underlying pathologies remain limited, and mechanical ventilation, which removes carbon dioxide from the body, remains essential to achieving better clinical outcomes. This review aims to identify the best ARDS treatments that are currently available.

Downregulation of ROR2 attenuates LPS‐induced A549 cell injury through JNK and ERK signaling pathways

“…This novel mechanism provides novel potential therapeutic targets for ALI. However, the current research has some limitations: (1) the data in the present study were based on the A549 cell line, and there was a lack of primary lung endothelial cells; (2) we only focused on male mice, thus, the mechanistic and functional significance of ROR2 in female mice should be further verified; (3) the regulatory mechanism of ROR2 action also requires further investigation.…”

“…Acute respiratory distress syndrome (ARDS) is a common and devastating clinical illness characterized by impaired oxygenation (refractory hypoxemia), pulmonary edema, decreased lung compliance, bilateral diffuse pulmonary infiltration, the loss of alveolar barrier function, and massive pulmonary and systemic release of pro‐inflammatory mediators. 1 , 2 Acute lung injury (ALI), considered as the early clinical manifestation of ARDS, results from direct and indirect pulmonary insults. 3 …”

Prevalence and Outcome of Management of Respiratory Distress Syndrome: A Systematic Review

“…According to data, several ventilatory methods may worsen alveolar damage and prolong lung injury in the context of ARDS. Preventing volutrauma (exposed to large tidal volumes), barotrauma (exposed to high plateau pressures), and atelectrauma (exposed to atelectasis) is a priority [26,27].…”

Effects of driving pressure-guided ventilation on postoperative pulmonary complications in patients with COVID-19 undergoing abdominal surgery: A post-hoc propensity score-matched analysis

“…It was reported an increasing incidence of mortality and pulmonary complications in patients undergoing surgery with perioperative SARS-CoV-2 infection [ 7 ]. The lung protective ventilation strategy (LPVS) with low tidal volume and positive end-expiratory pressure (PEEP) had been proved to improve oxygenation and reduce the mortality rate in patients with acute respiratory distress syndrome (ARDS) [ 8 ]. Meanwhile, the lung protective ventilation strategy was also recommended for patients with high-risk PPCS undergoing elective general anesthesia [ 9 ].…”