Acute Respiratory Distress Syndrome
Acute respiratory distress syndrome (ARDS) is a syndrome characterized by increased permeability pulmonary edema, lung inflammation, hypoxemia, and decreased lung compliance. Clinical criteria include bilateral opacities on chest imaging, hypoxemia with a PaO2/FIO2 ratio < 300 mm Hg with positive end-expiratory pressure (PEEP) ≥ 5 cm H2O, and the respiratory failure cannot fully be explained by cardiac failure or fluid overload. Causes of ARDS can be categorized into those resulting from direct injury to the lungs (e.g., pneumonia, aspiration, toxic inhalation, near-drowning) and those from indirect injury to the lungs (e.g., sepsis, trauma, pancreatitis, blood transfusions). Lung inflammation in ARDS causes alveolar injury, leaky pulmonary capillaries, exudation of proteinaceous fluid into alveoli, and alveolar collapse. Patients with ARDS often require mechanical ventilation because of the increased work of breathing from decreased lung compliance and impaired gas exchange.
KeywordsAcute respiratory distress syndrome (ARDS) Volutrauma Barotrauma Atelectrauma Positive end-expiratory pressure (PEEP) Opening pressure Closing pressure Permissive hypercapnia
- 2.Cairo J. Pilbeam’s mechanical ventilation: physiological and clinical applications. 5th ed. St. Louis: Mosby; 2012.Google Scholar
- 3.MacIntyre N, Branson R. Mechanical ventilation. 2nd ed. Philadelphia: Saunders; 2009.Google Scholar
- 4.Broaddus V, Ernst J. Murray and Nadel’s textbook of respiratory medicine. 5th ed. Philadelphia: Saunders; 2010.Google Scholar
- 6.Tobin M. Principles and practice of mechanical ventilation. 3rd ed. Beijing: McGraw-Hill; 2013.Google Scholar
- 7.West J. Pulmonary pathophysiology: the essentials. 8th ed. Beijing: Lippincott Williams & Wilkins; 2013.Google Scholar