Topics in acute respiratory distress syndrome: the patient needs our tender loving and care

Abstract

@ERSpublicationsThis editorial introduces a new series on acute respiratory distress syndrome summarising important clinical studies http://ow.ly/vDomD This editorial introduces a four-part series on acute respiratory distress syndrome (ARDS) that will cover a wide range of related topics in reviews written by internationally renowned experts. The first part of this series will be published in this issue of the European Respiratory Review by GUÉ RIN [1] on the role of prone positioning. This will be followed by articles on the topics of: 1) the role of imaging in the diagnosis and management of ARDS; 2) the novel ventilatory aspects involved in managing patients with ARDS; and 3) how to manage a patient failing conventional ventilation with extracorporeal support, in particular, extracorporeal membrane oxygenation (ECMO).It is nearly 50 years since the first report of ''acute respiratory distress in adults'' by ASHBAUGH et al. [2]. This later became known as ARDS and acute lung injury (ALI). This group of conditions was characterised by acute onset of hypoxaemia associated with the presence of bilateral infiltrates on chest radiography, poor lung compliance and the exclusion of cardiogenic pulmonary oedema [3]. ARDS may develop after a diverse spectrum of causes. These associated conditions may be categorised according to the nature of the insult with, for example, pulmonary sepsis causing a ''direct'' insult whilst pancreatitis and non-pulmonary sepsis cause an ''indirect'' insult resulting in ARDS often as part of multi-organ dysfunction syndrome. Despite some evidence of improvements in mortality in selected centres over recent decades, ARDS remains a major public health problem with a 28-day mortality in the region of 25-35%, and a corresponding large fiscal burden to national health services [4].In 1994, an American-European Consensus Conference (AECC) formalised the criteria for the diagnosis of ARDS and ALI. Thus, ARDS was defined by an arterial oxygen tension (PaO 2 )/inspiratory oxygen fraction (FIO 2 ) ratio of ,150 and ALI, at the milder end of the spectrum, as a PaO 2 /FIO 2 ratio of ,300 [5]. The definition of noncardiogenic pulmonary oedema was confirmed by a pulmonary artery wedge pressure of ,18 mmHg, necessitating the use of a Swan-Ganz catheter to make the formal definition. Although that definition is simple to apply in the clinical setting, it has been challenged over the years. For instance, it makes no sense that ALI could theoretically include all patients with a PaO 2 /FIO 2 ,300. It also makes no attempt to prognosticate in terms of severity of injury. Also, it does not take into account the effect of ventilatory support. In 2011, in an attempt to address these issues and others, experts from Europe and the

Moderate/severe acute respiratory distress syndrome in patients with or without traumatic brain injury

“…5 Because of the multiplicity of aetiologies and clinical settings, there is speculation whether ARDS should be characterised as a single entity or whether for each special situation such as intra-abdominal hypertension, obesity, pneumonia by influenza, it could be characterised as a class of ARDS, with differences of clinical and ventilatory management. [6][7][8] The aim of this study was to compare the outcomes of patients with TBI with or without moderate/severe ARDS and to verify if in patients with TBI with moderate/severe ARDS, clinical and physiological characteristics and outcomes are different from those in patients with ARDS secondary to other non-traumatic aetiologies.…”

Extracorporeal support for patients with acute respiratory distress syndrome

“…Does ECMO support have a role in the care of patients with severe ARDS? When should it be employed in the complex patient pathway [4], which includes diagnosis, fluid management, careful mechanical ventilation, prone ventilation [5] and the avoidance of complications such as ventilator associated pneumonia?…”

TheEuropean Respiratory Review: farewell from the editor with confidence for the future

“…connective tissue disease, interventional bronchoscopy, childhood tuberculosis and the impact of climate change on respiratory disease). Thematic review series have also been introduced in the Review, with four series published in 2013-2015 on thoracic oncology [3], pulmonary rehabilitation [4], acute respiratory distress syndrome [5], and asthma [6]. The Review also publishes ERS task force reports and supportive documents [7][8][9][10][11][12], as illustrated in this issue, which contains a comprehensive statement on the multidisciplinary respiratory management of ataxia telangiectasia [13].…”