Acute respiratory distress syndrome

Acute respiratory distress syndrome is the clinical manifestation of severe, acute lung injury. It is characterized by the acute onset of diffuse, bilateral pulmonary infiltrates secondary to noncardiogenic pulmonary edema, refractory hypoxia, and decreased lung compliance. Acute respiratory distress syndrome occurs most frequently in the setting of sepsis, aspiration of gastric contents, trauma, or multiple transfusions. Its complex pathophysiology involves an inciting local or systemic event that initiates pulmonary endothelial and epithelial damage and subsequent increased permeability. Tachypnea, hypoxia, and respiratory alkalosis are typical early clinical manifestations, and they are usually followed by the appearance of diffuse pulmonary infiltrates and respiratory failure within 48 hours. Early identification and treatment of the underlying disorder, along with aggressive supportive care, are essential. Experimental therapies, including those using nitric oxide and surfactant, have not been shown to improve mortality in patients with ARDS, but new therapeutic approaches such as low-volume ventilation have been shown to decrease mortality. Many patients who survive ARDS have permanent, mild to moderate impairment of lung function. Quality of life after hospitalization with ARDS may be poorer than that in similar patients without ARDS.     

Acute respiratory distress syndrome

Current literature on acute respiratory distress-syndrome (ARDS) is reviewed with characteristics of the terms "acute pulmonary lesion" and "ARDS". Clinical and x-ray classifications of ARDS are presented. Etiology and pathogenesis, epidemiology, clinical manifestations and principles of current treatment are discussed. Use of mechanical ventilation of the lungs in ARDS patients is physiologically validated. Much attention is payed to application of natural and artificial surfactants.     

Acute respiratory distress syndrome

Acute respiratory distress syndrome is a manifestation of acute injury to the lung, commonly resulting from sepsis, trauma, and severe pulmonary infections. Clinically, it is characterized by dyspnea, profound hypoxemia, decreased lung compliance, and diffuse bilateral infiltrates on chest radiography. Provision of supplemental oxygen, lung rest, and supportive care are the fundamentals of therapy. The management of acute respiratory distress syndrome frequently requires endotracheal intubation and mechanical ventilation. A low tidal volume and low plateau pressure ventilator strategy is recommended to avoid ventilator-induced injury. Timely correction of the inciting clinical condition is essential for preventing further injury. Various medications directed at key stages of the pathophysiology have not been as clinically efficacious as the preceding experimental trials indicated. Complications such as pneumothorax, effusions, and focal pneumonia should be identified and promptly treated. In refractory cases, advanced ventilator and novel techniques should be considered, preferably in the setting of clinical trials. During the past decade, mortality has declined from more than 50 percent to about 32 to 45 percent. Death usually results from multisystem organ failure rather than respiratory failure alone.     

急性呼吸窘迫综合征影像学表现

目的提高对急性呼吸窘迫综合征（ARDS）影像学表现的认识与鉴别,早期诊断ARDS以降低病死率。方法回顾分析18例不同病因引起的ARDS患者的普通x线、cT的影像学特点、病理、实验室检查等且与临床相结合,诊断ARDS。结果排除大片肺不张、自发性气胸、上气道阻塞、急性肺拴塞和心源性肺水肿等,通过x线表现与病史及临床表现相结合作出正确诊断。结论病因不同ARDS有共同生理学、病理学和影像学特征。     

Acute respiratory distress syndrome: Underrecognition by clinicians

Background

Previous reports suggest that acute lung injury (ALI)/acute respiratory distress syndrome (ARDS) is underdiagnosed in both adult and pediatric clinical practice. Underrecognition of this condition may be a barrier to instituting a low tidal volume ventilation strategy. This study aimed to determine the accuracy of clinical diagnoses of ARDS in daily practice using the American European Consensus Conference (AECC) criteria as a criterion standard and to investigate whether clinical recognition of ARDS altered ventilator management.

Methods

This retrospective study included intensive care unit (ICU) patients who died and underwent postmortem examination. Two independent reviewers assigned each patient to those with ALI/ARDS or no ALI. For those who met AECC criteria for ARDS, all patient records were reviewed for the presence of a documented diagnosis of the condition. The accuracy of the clinicians in diagnosing ALI/ARDS was determined, and ventilator settings between the clinically “diagnosed” and “non-diagnosed” groups were compared. The diagnostic accuracy in predetermined subgroups (those with diffuse alveolar damage, with ≥ 3 affected chest x-ray quadrants, with diagnosis ≥ 3 days, with pulmonary vs extrapulmonary cause) was also examined.

Results

Of 98 consecutive ICU patients who died and underwent autopsy, 51 met the inclusion criteria. Sixteen of 51 patients (31.3%) who had ALI/ARDS according to the AECC criteria had this recorded in their clinical notes. Those with histologic evidence of ALI/ARDS (diffuse alveolar damage) and with a more severe chest x-ray pattern or who satisfied the criteria for a number of consecutive days were no more likely to have a clinical diagnosis of ALI/ARDS recorded. However, those with a pulmonary cause of ALI/ARDS were more likely to have a diagnosis recorded. Tidal volumes, positive end-expiratory pressure, and mean airway pressure were higher in those with a clinical diagnosis of ARDS.

Conclusions

Acute respiratory distress syndrome is underrecognized by clinicians in ICU, and recognition does not result in lower tidal volume ventilation. Significant barriers remain to the recognition of ALI/ARDS and application of an evidence-based ventilator strategy.     

Adult respiratory distress syndrome and its management

ARDS is a relatively common disorder whose high mortality has changed little over the past few years. Management remains supportive in essence, consisting of careful ventilatory management and attention to fluid balance and nutritional needs. Certain complications, especially sepsis, need to be prevented if possible. Currently, there is no pharmacologic intervention of proven benefit. Future improvements in the treatment of ARDS will depend on new research incorporating both laboratory and clinical approaches.     

Acute respiratory distress syndrome: low-stretch ventilation improves survival

In a recent major study, patients with acute respiratory distress syndrome or acute lung injury were randomly assigned to have their respirators set to deliver tidal volumes of either 6 mL/kg or a more-traditional 12 mL/kg. Mortality in the low-tidal-volume group was 31.0%, compared with 39.8% in the traditional-tidal-volume group, a 22% difference (P = .007).     

Acute respiratory distress syndrome (ARDS)

The acute respiratory distress syndrome (ARDS) is a common clinical catastrophe following acute lung injury. A multiplicity of clinical states can lead to ARDS. A new classification system has been proposed to deal with associated organ system failure and varying degrees of acute lung injury. ARDS is a permeability and inflammatory edema with damage and destruction at the air blood interface. Many cellular and humoral mediators probably attack the lung's surfactant system which in turn enhances edema formation. Supportive care with mechanical ventilation and positive end expiratory pressure results with the salvage of less than 50% of patients. Lung regeneration requires weeks or months to become complete in those who survive. Thus far no individual pharmacological agents have been shown to alter prognosis. Controlled clinical trials are required to evaluate new and older pharmacological agents alone or in combination, and surfactant replacement.     

Acute respiratory distress syndrome: clinical recognition and preventive management in chiropractic acute care practice

OBJECTIVE: To present clinical information relevant to acute respiratory distress syndrome (ARDS) and its appearance in chiropractic acute care practice. DATA SOURCES: The National Library of Medicine MEDLINE database was used, along with the bibliographies of selected articles and textbooks commonly found in chiropractic college libraries and bookstores. STUDY SELECTION: Clinical studies from the English literature were selected if they pertained to incidence, clinical relevancy, or the association of ARDS with commonly-seen diagnoses in chiropractic neuromusculoskeletal or orthopedic practice. DATA EXTRACTION: All relevant studies identified by the search were evaluated based on information pertinent to chiropractic management of acute care patients. RESULTS: ARDS is a pulmonary distress syndrome with a high mortality rate. Recognizable indications for the possible development of ARDS include chest pain, head injury, and thoracic spine pain with or without trauma. Clinical evaluation, radiographic findings, and laboratory findings are presented to assist practitioners in identifying this disease process of multiple etiology. A study of the basic pathophysiologic processes that occur in the formation of ARDS is presented to help practitioners gain clinical appreciation. Strategies for preventing respiratory distress in chiropractic patients are also presented and include use of the postural position and the clinical maxim of "slow, deep breathing despite pain" to lessen incident rates of subjects at risk. CONCLUSION: Although ARDS may not be prevalent in chiropractic practice, it is important for physicians to be aware of the clinical basics (including its pathophysiology), its medical significance, and the preventive strategies that may be used to minimize its occurrence. This basic understanding will further advance knowledge of this disease complex.     

Acute respiratory distress syndrome: a clinical update.

BACKGROUND: Because of recent advances in the treatment and improved outcome of acute respiratory distress syndrome (ARDS), we present an overview of ARDS to update general practitioners on the management of this condition. METHODS AND RESULTS: We searched MEDLINE for original articles, editorials, and reviews on ARDS, acute lung injury, and mechanical ventilation. A large amount of data is available on this subject. We reviewed relevant articles that address definition, pathogenesis, clinical presentation, and management of ARDS, giving special emphasis to ventilatory support of patients with ARDS. CONCLUSION: Acute respiratory distress syndrome is a severe form of acute lung injury associated with significant mortality and morbidity. In recent years, significant progress has been made in the understanding of this condition, but the management of ARDS remains complex and requires multidisciplinary and specialized care.     

Acute respiratory distress syndrome in pediatric cardiosurgery

The prognosis in acute respiratory distress syndrome (ARDS) is poor; its mortality is generally 40-60%. The mortality in patients with ARDS is more commonly associated with the sequels of sepsis and multiple organ dysfunction than with respiratory failure although the latest papers on protective ventilation suggest that death in these patients directly results from lung lesion in a number of cases. There have been encouraging data on the reduced mortality rates due to acute lung lesion/ARDS in the past decade. The development and introduction of new technologies of respiratory support, the emergence of new effective treatments for sepsis, and the improvement of general maintenance therapy in patients with ARDS may be a possible explanation for such changes for the best.     

Acute respiratory distress syndrome during neutropenia recovery

Acute respiratory failure is a life-threatening complication in cancer patients. During neutropenia, patients are at high risk for bacterial pneumonia or invasive fungal infections, when neutropenia is prolonged. A high proportion of patients in whom neutropenia had been complicated by pneumonia will present with substantial respiratory deterioration during neutropenia recovery. Patients with fungal pneumonia and those receiving granulocyte colony-stimulating factor to shorten neutropenia duration may be at higher risk for this acute lung injury/acute respiratory distress syndrome during neutropenia recovery. Routine screening of patient's risk factors is crucial since first symptoms of acute respiratory distress syndrome may occur before biological leukocyte recovery.