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Current Concepts of ARDS: A Narrative Review
Acute respiratory distress syndrome (ARDS) is characterized by the acute onset of pulmonary edema of non-cardiogenic origin, along with bilateral pulmonary infiltrates and reduction in respiratory system compliance. The hallmark of the syndrome is refractory hypoxemia. Despite its first description...
Autores principales: | , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
MDPI
2016
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5297699/ https://www.ncbi.nlm.nih.gov/pubmed/28036088 http://dx.doi.org/10.3390/ijms18010064 |
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author | Umbrello, Michele Formenti, Paolo Bolgiaghi, Luca Chiumello, Davide |
author_facet | Umbrello, Michele Formenti, Paolo Bolgiaghi, Luca Chiumello, Davide |
author_sort | Umbrello, Michele |
collection | PubMed |
description | Acute respiratory distress syndrome (ARDS) is characterized by the acute onset of pulmonary edema of non-cardiogenic origin, along with bilateral pulmonary infiltrates and reduction in respiratory system compliance. The hallmark of the syndrome is refractory hypoxemia. Despite its first description dates back in the late 1970s, a new definition has recently been proposed. However, the definition remains based on clinical characteristic. In the present review, the diagnostic workup and the pathophysiology of the syndrome will be presented. Therapeutic approaches to ARDS, including lung protective ventilation, prone positioning, neuromuscular blockade, inhaled vasodilators, corticosteroids and recruitment manoeuvres will be reviewed. We will underline how a holistic framework of respiratory and hemodynamic support should be provided to patients with ARDS, aiming to ensure adequate gas exchange by promoting lung recruitment while minimizing the risk of ventilator-induced lung injury. To do so, lung recruitability should be considered, as well as the avoidance of lung overstress by monitoring transpulmonary pressure or airway driving pressure. In the most severe cases, neuromuscular blockade, prone positioning, and extra-corporeal life support (alone or in combination) should be taken into account. |
format | Online Article Text |
id | pubmed-5297699 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2016 |
publisher | MDPI |
record_format | MEDLINE/PubMed |
spelling | pubmed-52976992017-02-10 Current Concepts of ARDS: A Narrative Review Umbrello, Michele Formenti, Paolo Bolgiaghi, Luca Chiumello, Davide Int J Mol Sci Review Acute respiratory distress syndrome (ARDS) is characterized by the acute onset of pulmonary edema of non-cardiogenic origin, along with bilateral pulmonary infiltrates and reduction in respiratory system compliance. The hallmark of the syndrome is refractory hypoxemia. Despite its first description dates back in the late 1970s, a new definition has recently been proposed. However, the definition remains based on clinical characteristic. In the present review, the diagnostic workup and the pathophysiology of the syndrome will be presented. Therapeutic approaches to ARDS, including lung protective ventilation, prone positioning, neuromuscular blockade, inhaled vasodilators, corticosteroids and recruitment manoeuvres will be reviewed. We will underline how a holistic framework of respiratory and hemodynamic support should be provided to patients with ARDS, aiming to ensure adequate gas exchange by promoting lung recruitment while minimizing the risk of ventilator-induced lung injury. To do so, lung recruitability should be considered, as well as the avoidance of lung overstress by monitoring transpulmonary pressure or airway driving pressure. In the most severe cases, neuromuscular blockade, prone positioning, and extra-corporeal life support (alone or in combination) should be taken into account. MDPI 2016-12-29 /pmc/articles/PMC5297699/ /pubmed/28036088 http://dx.doi.org/10.3390/ijms18010064 Text en © 2016 by the authors; licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC-BY) license (http://creativecommons.org/licenses/by/4.0/). |
spellingShingle | Review Umbrello, Michele Formenti, Paolo Bolgiaghi, Luca Chiumello, Davide Current Concepts of ARDS: A Narrative Review |
title | Current Concepts of ARDS: A Narrative Review |
title_full | Current Concepts of ARDS: A Narrative Review |
title_fullStr | Current Concepts of ARDS: A Narrative Review |
title_full_unstemmed | Current Concepts of ARDS: A Narrative Review |
title_short | Current Concepts of ARDS: A Narrative Review |
title_sort | current concepts of ards: a narrative review |
topic | Review |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5297699/ https://www.ncbi.nlm.nih.gov/pubmed/28036088 http://dx.doi.org/10.3390/ijms18010064 |
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