Acute respiratory distress syndrome

Nuala J Meyer, Luciano Gattinoni, Carolyn S Calfee, Nuala J Meyer, Luciano Gattinoni, Carolyn S Calfee

Abstract

Acute respiratory distress syndrome (ARDS) is an acute respiratory illness characterised by bilateral chest radiographical opacities with severe hypoxaemia due to non-cardiogenic pulmonary oedema. The COVID-19 pandemic has caused an increase in ARDS and highlighted challenges associated with this syndrome, including its unacceptably high mortality and the lack of effective pharmacotherapy. In this Seminar, we summarise current knowledge regarding ARDS epidemiology and risk factors, differential diagnosis, and evidence-based clinical management of both mechanical ventilation and supportive care, and discuss areas of controversy and ongoing research. Although the Seminar focuses on ARDS due to any cause, we also consider commonalities and distinctions of COVID-19-associated ARDS compared with ARDS from other causes.

Copyright © 2021 Elsevier Ltd. All rights reserved.

Figures

Figure 1
Figure 1
Chest radiographs (A) Vaping-associated lung injury with pneumomediastinum (arrows). (B) SARS-CoV-2 infection.
Figure 2
Figure 2
Lung ultrasound image showing B lines B lines (arrows) are the vertical lines in the lower half of the image. Diffuse B lines (≥3 per region in multiple fields) are consistent with pulmonary oedema or acute respiratory distress syndrome.
Figure 3
Figure 3
Areas of consensus and controversy in ARDS management Central box shows the areas of consensus. Blue boxes show areas of controversy and new directions. ARDS=acute respiratory distress syndrome. ECMO=extracorporeal membrane oxygenation. FiO2=fraction of inspired oxygen. PaO2=partial pressure of oxygen.

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