Acute Respiratory Distress Syndrome
Michele Umbrello, Paolo Formenti, Davide Chiumello
Abstract
Abstract Summary Acute respiratory distress syndrome (ARDS) is characterized by non-cardiogenic pulmonary oedema with bilateral chest X-ray opacities and reduction in respiratory system compliance. The hallmark of the syndrome is hypoxaemia refractory to oxygen therapy. Although the standard supportive treatment remains mechanical ventilation (both non-invasive and invasive), adjuvant therapies can be considered. Therapeutic approaches to ARDS, including lung-protective ventilation, prone positioning, inhaled vasodilators, neuromuscular blockade, steroids, and recruitment manoeuvres, will be reviewed. In patients with ARDS, a holistic framework of respiratory and haemodynamic support should be provided, aiming to ensure adequate gas exchange while minimizing the risk of ventilator-induced lung injury, by promoting lung recruitment and protective mechanical ventilation. To do so, lung recruitability should be considered, while avoiding lung overstress and consequent strain, by monitoring airway driving pressure or transpulmonary pressure. In the most severe cases, neuromuscular blockade, prone positioning, and extracorporeal membrane oxygenation (alone or in combination) should be considered.