Acute Respiratory Distress Syndrome

Thompson, B. Taylor; Chambers, Rachel C.; Liu, Kathleen D.

doi:10.1056/nejmra1608077

Cited by 1,425 publications

(1,481 citation statements)

References 61 publications

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“…The resulting unbalanced response leads to accumulation of protein-rich fluid in the alveolar space and the interstitium [38]. This process can be initiated by direct damage to the lung (e.g.…”

Section: Pharmacological Interventionsmentioning

confidence: 99%

ARDS: challenges in patient care and frontiers in research

2018

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This review discusses the clinical challenges associated with ventilatory support and pharmacological interventions in patients with acute respiratory distress syndrome (ARDS). In addition, it discusses current scientific challenges facing researchers when planning and performing trials of ventilatory support or pharmacological interventions in these patients.Noninvasive mechanical ventilation is used in some patients with ARDS. When intubated and mechanically ventilated, ARDS patients should be ventilated with low tidal volumes. A plateau pressure <30 cmH 2 O is recommended in all patients. It is suggested that a plateau pressure <15 cmH 2 O should be considered safe. Patient with moderate and severe ARDS should receive higher levels of positive endexpiratory pressure (PEEP). Rescue therapies include prone position and neuromuscular blocking agents. Extracorporeal support for decapneisation and oxygenation should only be considered when lungprotective ventilation is no longer possible, or in cases of refractory hypoxaemia, respectively. Tracheotomy is only recommended when prolonged mechanical ventilation is expected.Of all tested pharmacological interventions for ARDS, only treatment with steroids is considered to have benefit.Proper identification of phenotypes, known to respond differently to specific interventions, is increasingly considered important for clinical trials of interventions for ARDS. Such phenotypes could be defined based on clinical parameters, such as the arterial oxygen tension/inspiratory oxygen fraction ratio, but biological marker profiles could be more promising.

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Section: Pharmacological Interventionsmentioning

confidence: 99%

ARDS: challenges in patient care and frontiers in research

2018

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“…Acute respiratory distress syndrome (ARDS) is characterized by widespread lung inflammation with permeability alteration of the lung microvasculature and edema involving the whole lung parenchyma [2,31,38]. No etiologic treatment is available and supportive treatment with mechanical ventilation is associated with a mortality rate of up to 43% in severe ARDS [3].…”

Section: Introductionmentioning

confidence: 99%

“…Mead showed that the applied pressure is regionally multiplied at the interface between lung regions with different inflation statuses [7,13]. A second possible mechanism of ventilator-induced lung injury (VILI) in a diseased lung is intratidal collapse and decollapse of lung units (atelecrauma) [32,38], which may be seen both as an extension of the Mead model or a different disease mechanism. Lung damage may occur at the small airway level where the applied pressure acts on the .…”

Section: Introductionmentioning

confidence: 99%

Does high PEEP prevent alveolar cycling?

Cressoni

Chiurazzi

Chiumello

et al. 2017

Med Klin Intensivmed Notfmed

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“…In both scenarios, activated neutrophils recruited to the lung will promote tissue injury by releasing oxidants, proteases, other inflammatory mediators and neutrophil extracellular traps (NETs) [4]. This robust inflammatory reaction leads to platelet aggregation and microthrombus formation in the lung vasculature, endothelial and epithelial cell death, loss of barrier function, and flooding of the interstitial space and alveoli [5]. While ARDS is used as an umbrella term to denote this inflammatory lung condition, whether this is one disease or multiple diseases is unknown.…”

mentioning

confidence: 99%

“…While ARDS is used as an umbrella term to denote this inflammatory lung condition, whether this is one disease or multiple diseases is unknown. Nevertheless, numerous therapies aimed at suppressing or modulating inflammation for the treatment of ARDS have been investigated clinically, yet have failed to show a mortality benefit [3,5]. Thus, further research, particularly human research, is still needed to better understand the complex and heterogeneous immunological processes involved in the pathophysiology of ARDS.…”

mentioning

confidence: 99%