Acute respiratory distress syndrome
Nat Rev Dis Primers.
Matthay MA1, Zemans RL2, Zimmerman GA3, Arabi YM4, Beitler JR5, Mercat A6, Herridge M7, Randolph AG8, Calfee CS9.
1 Cardiovacular Research Institute, University of California-San Francisco, San Francisco, CA, USA. firstname.lastname@example.org.
2 Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA.
3 Department of Internal Medicine, University of Utah, Salt Lake City, UT, USA.
4 Intensive Care Department, King Saud bin Abdulaziz University for Health Sciences and King Abdullah International Medical Research Center, Riyadh, Saudi Arabia.
5 Center for Acute Respiratory Failure and Department of Internal Medicine, Columbia University, New York, NY, USA.
6 Department of Intensive Care, University of Angers, Angers, France.
7 Interdepartmental Division of Critical Care Medicine, University of Toronto, University Health Network, Toronto, Ontario, Canada.
8 Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children’s Hospital, Harvard Medical School, Boston, MA, USA.
9 Cardiovacular Research Institute, University of California-San Francisco, San Francisco, CA, USA.
Year of Publication:
The acute respiratory distress syndrome (ARDS) is a common cause of respiratory failure in critically ill patients and is defined by the acute onset of noncardiogenic pulmonary oedema, hypoxaemia and the need for mechanical ventilation. ARDS occurs most often in the setting of pneumonia, sepsis, aspiration of gastric contents or severe trauma and is present in ~10% of all patients in intensive care units worldwide. Despite some improvements, mortality remains high at 30-40% in most studies. Pathological specimens from patients with ARDS frequently reveal diffuse alveolar damage, and laboratory studies have demonstrated both alveolar epithelial and lung endothelial injury, resulting in accumulation of protein-rich inflammatory oedematous fluid in the alveolar space. Diagnosis is based on consensus syndromic criteria, with modifications for under-resourced settings and in paediatric patients. Treatment focuses on lung-protective ventilation; no specific pharmacotherapies have been identified. Long-term outcomes of patients with ARDS are increasingly recognized as important research targets, as many patients survive ARDS only to have ongoing functional and/or psychological sequelae. Future directions include efforts to facilitate earlier recognition of ARDS, identifying responsive subsets of patients and ongoing efforts to understand fundamental mechanisms of lung injury to design specific treatments.