Current incidence and outcome of the acute respiratory distress syndrome

Villar, Jesús; Blanco, Jesús; Kacmarek, Robert M.

doi:10.1097/mcc.0000000000000266

Cited by 186 publications

(175 citation statements)

References 29 publications

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“…Although the recent Berlin definition [5] is probably much better than previous ones, there is still a high variability in both epidemiology and clinical outcomes in diverse healthcare settings [4]. In fact, the incidence of ARDS ranges from 1.5 cases per 100 000 [2] to nearly 79 cases per 100 000 [3], with European countries reporting a lower incidence than USA [6]. Moreover, studies from Brazil reported incidence rates ranging from 1.8 to 31 per 100 000 [7,8].…”

Section: Definition and Epidemiologymentioning

confidence: 99%

Acute respiratory distress syndrome

2017

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Since its first description, the acute respiratory distress syndrome (ARDS) has been acknowledged to be a major clinical problem in respiratory medicine. From July 2015 to July 2016 almost 300 indexed articles were published on ARDS. This review summarises only eight of them as an arbitrary overview of clinical relevance: definition and epidemiology, risk factors, prevention and treatment. A strict application of definition criteria is crucial, but the diverse resource-setting scenarios foster geographic variability and contrasting outcome data. A large international multicentre prospective cohort study including 50 countries across five continents reported that ARDS is underdiagnosed, and there is potential for improvement in its management. Furthermore, epidemiological data from low-income countries suggest that a revision of the current definition of ARDS is needed in order to improve its recognition and global clinical outcome. In addition to the well-known risk-factors for ARDS, exposure to high ozone levels and low vitamin D plasma concentrations were found to be predisposing circumstances. Drug-based preventive strategies remain a major challenge, since two recent trials on aspirin and statins failed to reduce the incidence in atrisk patients. A new disease-modifying therapy is awaited: some recent studies promised to improve the prognosis of ARDS, but mortality and disabling complications are still high in survivors in intensive care. Definition and epidemiologySince its first description by ASHBAUGH et al. [1] in 1967, the acute respiratory distress syndrome (ARDS) has been widely recognised as a major clinical problem worldwide, carrying a high morbidity and mortality burden [2][3][4]. Although the recent Berlin definition [5] is probably much better than previous ones, there is still a high variability in both epidemiology and clinical outcomes in diverse healthcare settings [4]. In fact, the incidence of ARDS ranges from 1.5 cases per 100 000 [2] to nearly 79 cases per 100 000 [3], with European countries reporting a lower incidence than USA [6]. Moreover, studies from Brazil reported incidence rates ranging from 1.8 to 31 per 100 000 [7,8].Although the overall survival rate is improving [9,10], there is a notable difference when considering in-hospital mortality over several observational studies [2][3][4][8][9][10][11]. This may be explained by differences in risk factors, availability of diagnostics, ability to recognise ARDS and some selection biases affecting clinical trials [12]. Recently, a large international observational study (the LUNG SAFE trial) evaluated the incidence of ARDS across 459 intensive care units (ICUs) in 50 countries [13]. To assess the clinical recognition of ARDS according to the latest definition, any patient inclusion into the trial was made through a computer algorithm following the Berlin criteria [5], and then compared to the diagnosis made by the attending physicians. Among 4499 patients who developed acute hypoxaemic respiratory failure, ARDS occurred in 1...

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Section: Definition and Epidemiologymentioning

confidence: 99%

Acute respiratory distress syndrome

2017

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“…The acute respiratory distress syndrome (ARDS) is an acute inflammatory process of the lungs caused by direct or indirect insults to the alveolar-capillary membrane (1)(2)(3)(4)(5), and is associated with an overall mortality ranging from 35% to 50% (6). Pathologically, ARDS is characterized by diffuse alveolar damage (DAD) with injury to the epithelium and endothelium as well as interstitial and alveolar protein-rich edema, inflammatory cellular infiltration, atelectasis, capillary thrombosis, neovascularization, and pulmonary fibrosis (7).…”

Section: Introductionmentioning

confidence: 99%

Biomarkers for the acute respiratory distress syndrome: how to make the diagnosis more precise

García‐Laorden¹,

Lorente²,

Flores³

et al. 2017

Ann. Transl. Med.

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103

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Abstract:The acute respiratory distress syndrome (ARDS) is an acute inflammatory process of the lung caused by a direct or indirect insult to the alveolar-capillary membrane. Currently, ARDS is diagnosed based on a combination of clinical and physiological variables. The lack of a specific biomarker for ARDS is arguably one of the most important obstacles to progress in developing novel treatments for ARDS. In this article, we will review the current understanding of some appealing biomarkers that have been measured in human blood, bronchoalveolar lavage fluid (BALF) or exhaled gas that could be used for identifying patients with ARDS, for enrolling ARDS patients into clinical trials, or for better monitoring of patient's management. After a literature search, we identified several biomarkers that are associated with the highest sensitivity and specificity for the diagnosis or outcome prediction of ARDS: receptor for advanced glycation end-products (RAGE), angiopoietin-2 (Ang-2), surfactant protein D (SP-D), inteleukin-8, Fas and Fas ligand, procollagen peptide (PCP) I and III, octane, acetaldehyde, and 3-methylheptane. In general, these are cell-specific for epithelial or endothelial injury or involved in the inflammatory or infectious response. No biomarker or biomarkers have yet been confirmed for the diagnosis of ARDS or prediction of its prognosis.However, it is anticipated that in the near future, using biomarkers for defining ARDS, or for determining those patients who are more likely to benefit from a given therapy will have a major effect on clinical practice.

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“…Dünya genelinde insidansı 1.5-79/100.000 olarak bildirilmekle birlikte, Avrupa ülkelerinde bu oran Amerika Birleşik Devletleri (ABD)'den daha düşüktür (2,3,6) . Brezilya'da 2013 tarihli yapılan çok merkezli bir çalışmada, bu oran 100.000'de 1.8 ile 31 bulunmuştur (7,8) .…”

Section: Introductionunclassified

Pediatric acute respiratory distress syndrome

Atay¹,

Nişli²

2017

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Current incidence and outcome of the acute respiratory distress syndrome

Cited by 186 publications

References 29 publications

Acute respiratory distress syndrome

Acute respiratory distress syndrome

Biomarkers for the acute respiratory distress syndrome: how to make the diagnosis more precise

Pediatric acute respiratory distress syndrome

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