Acute Respiratory Distress Syndrome: Etiology, Pathogenesis, and Summary on Management

Kaku, Shawn; Nguyen, Catherine; Htet, Natalie; Tutera, Dominic; Barr, Juliana; Paintal, Harman S.; Kuschner, Ware G.

doi:10.1177/0885066619855021

Cited by 65 publications

(58 citation statements)

References 208 publications

(229 reference statements)

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“…Additionally, proper nutritional support is crucial. 20 The mechanism underlying the development of preoperative hypoxaemia remains unclear. To the best of our knowledge, there is no published study reporting the association between femoral neck fracture and postoperative hypoxaemia.…”

Section: Discussionmentioning

confidence: 99%

Risk factors for and predictive nomogram of postoperative hypoxaemia in elderly patients with femoral neck fractures

et al. 2020

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Objective To investigate the related risk factors and predictive nomogram of postoperative hypoxaemia in elderly patients with femoral neck fractures. Methods This study included patients aged ≥65 years who underwent surgical treatment of acute femoral neck fractures. Univariate and multivariate logistic analyses were performed to determine the incidence of and risk factors for postoperative hypoxaemia. A predictive nomogram was constructed based on the multivariable model. Using the bootstrap method, discrimination was determined by the C-index and calibration plot. Results The logistic regression analysis showed that the anaesthesia type, surgical procedure, American Society of Anesthesiologists (ASA) classification, preoperative hypoxaemia occurrence, and age were independent predictors of development of postoperative hypoxaemia. The predictive formula for hypoxaemia was established as follows: hypoxaemia=−0.8668×spinal anaesthesia (whether)+0.1162×nerve anaesthesia (whether)+1.9555×plate/screw fixation (whether)+1.4950×hip replacement (whether)+0.4883×ASA classification+1.7153×preoperative oxygenation index+0.1608×age. With the bootstrap method, the prediction curve fit well with the ideal curve, suggesting that the prediction curve constructed in this study has good predictive ability. Conclusions Anaesthesia type, surgical procedure, ASA classification, preoperative hypoxaemia occurrence, and age were risk factors for postoperative hypoxaemia in elderly patients with femoral neck fractures. The predictive nomogram was designed for preoperative assessment of the risk of postoperative hypoxaemia by calculating the risk score.

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Section: Discussionmentioning

confidence: 99%

Risk factors for and predictive nomogram of postoperative hypoxaemia in elderly patients with femoral neck fractures

et al. 2020

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“…The mainstays of LPV are low V T , sufficient PEEP to maintain lung recruitment, and low airway pressures [17,[30][31][32][33][34]. Though ARDS is a heterogeneous syndrome, the following is recommended for all ARDS patients: (1) V T of 4 to 8 mL/kg predicted body weight (PBW) and ( 2) targeting a P Plat < 30 cm H 2 O (Tables 3 and 4) [15,34,35]. Emerging data from several American tertiary care centers support this approach in patients with COVID-19 requiring invasive mechanical ventilation [10].…”

Section: A Lung Protective Strategymentioning

confidence: 99%

Initial emergency department mechanical ventilation strategies for COVID-19 hypoxemic respiratory failure and ARDS

Lentz

Roginski

Montrief

et al. 2020

The American Journal of Emergency Medicine

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Introduction: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is an emerging viral pathogen that causes the novel coronavirus disease of 2019 (COVID-19) and may result in hypoxemic respiratory failure necessitating invasive mechanical ventilation in the most severe cases. Objective: This narrative review provides evidence-based recommendations for the treatment of COVID-19 related respiratory failure requiring invasive mechanical ventilation. Discussion: In severe cases, COVID-19 leads to hypoxemic respiratory failure that may meet criteria for acute respiratory distress syndrome (ARDS). The mainstay of treatment for ARDS includes a lung protective ventilation strategy with low tidal volumes (4-8 mL/kg predicted body weight), adequate positive end-expiratory pressure (PEEP), and maintaining a plateau pressure of <30 cm H 2 O. While further COVID-19 specific studies are needed, current management should focus on supportive care, preventing further lung injury from mechanical ventilation, and treating the underlying cause. Conclusions: This review provides evidence-based recommendations for the treatment of COVID-19 related respiratory failure requiring invasive mechanical ventilation.

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“…The most common risk factor for developing ARDS is pneumonia (35-50%), followed by non-pulmonary sepsis (30%), aspiration (10%), and trauma (10%) [5]. The pathogenesis of ARDS involves diffuse alveolar damage, inflammation with a cytokine storm and increased capillary permeability, resulting in the development of pulmonary edema, decreased lung compliance and impaired gas exchange [6]. The reabsorption of alveolar and interstitial fluid is associated with the proliferation of type II alveolar cells as well as fibroblasts and myofibroblasts producing components of the extracellular matrix.…”

Section: Introductionmentioning

confidence: 99%

Renin–Angiotensin System: An Important Player in the Pathogenesis of Acute Respiratory Distress Syndrome

Hrenak

Šimko

2020

IJMS

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Acute respiratory distress syndrome (ARDS) is characterized by massive inflammation, increased vascular permeability and pulmonary edema. Mortality due to ARDS remains very high and even in the case of survival, acute lung injury can lead to pulmonary fibrosis. The renin–angiotensin system (RAS) plays a significant role in these processes. The activities of RAS molecules are subject to dynamic changes in response to an injury. Initially, increased levels of angiotensin (Ang) II and des-Arg9-bradykinin (DABK), are necessary for an effective defense. Later, augmented angiotensin converting enzyme (ACE) 2 activity supposedly helps to attenuate inflammation. Appropriate ACE2 activity might be decisive in preventing immune-induced damage and ensuring tissue repair. ACE2 has been identified as a common target for different pathogens. Some Coronaviruses, including SARS-CoV-2, also use ACE2 to infiltrate the cells. A number of questions remain unresolved. The importance of ACE2 shedding, associated with the release of soluble ACE2 and ADAM17-mediated activation of tumor necrosis factor-α (TNF-α)-signaling is unclear. The roles of other non-classical RAS-associated molecules, e.g., alamandine, Ang A or Ang 1–9, also deserve attention. In addition, the impact of established RAS-inhibiting drugs on the pulmonary RAS is to be elucidated. The unfavorable prognosis of ARDS and the lack of effective treatment urge the search for novel therapeutic strategies. In the context of the ongoing SARS-CoV-2 pandemic and considering the involvement of humoral disbalance in the pathogenesis of ARDS, targeting the renin–angiotensin system and reducing the pathogen’s cell entry could be a promising therapeutic strategy in the struggle against COVID-19.

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Acute Respiratory Distress Syndrome: Etiology, Pathogenesis, and Summary on Management

Cited by 65 publications

References 208 publications

Risk factors for and predictive nomogram of postoperative hypoxaemia in elderly patients with femoral neck fractures

Risk factors for and predictive nomogram of postoperative hypoxaemia in elderly patients with femoral neck fractures

Initial emergency department mechanical ventilation strategies for COVID-19 hypoxemic respiratory failure and ARDS

Renin–Angiotensin System: An Important Player in the Pathogenesis of Acute Respiratory Distress Syndrome

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