Prevention of acute respiratory distress syndrome

Abstract

Purpose of review: The paucity of effective therapeutic interventions in patients with the acute respiratory distress syndrome (ARDS) combined with overwhelming evidence on the importance of timely implementation of effective therapies to critically ill patients has resulted in a recent shift in ARDS research. Increasingly, efforts are being directed toward early identification of patients at risk with a goal of prevention and early treatment, prior to development of the fully established syndrome. The focus of the present review is on the prevention of ARDS in patients without this condition at the time of their healthcare encounter.

Recent findings: The primary thematic categories presented in the present review article include early identification of patients at risk of developing ARDS, optimization of care delivery and its impact on the incidence of ARDS, pharmacological prevention of ARDS, prevention of postoperative ARDS, and challenges and opportunities with ARDS prevention studies.

Summary: Recent improvements in clinical care delivery have been associated with a decrease in the incidence of hospital-acquired ARDS. Despite the initial challenges, research in ARDS prevention has become increasingly feasible with several randomized controlled trials on ARDS prevention completed or on the way.

Conflict of interest statement

Conflicts of interest: Dr. Festic has no conflicts of interest relevant to this publication. Dr. Kor receives royalties from Up-to-Date for authoring a chapter on the topic of Transfusion-Related Acute Lung Injury. Mayo Clinic and Dr. Ognjen Gajic hold the patent application on critical care related software applications licensed to Ambient Clinical Analytics Inc.

Figures

Figure 1

Lung Injury Prediction Score (LIPS) calculation worksheet. From: Gajic O, Dabbagh O, Park PK, et al. Early identification of patients at risk of acute lung injury: evaluation of lung injury prediction score in a multicenter cohort study. American Journal of Respiratory & Critical Care Medicine. 2011;183(4):462-70. [8]

Figure 2

Proposed alternative pathophysiology of ARDS. From: Albert RK. The role of ventilation-induced surfactant dysfunction and atelectasis in causing acute respiratory distress syndrome. Am J RespCrit Care Med 2012;185(7):702-708. [19]

Figure 3

Checklist for Lung Injury Prevention (CLIP).

Figure 4

Emerging pharmacological therapies for ARDS prevention. Modified from: Ortiz-Diaz E, Festic E, Gajic O, Levitt JE. Emerging pharmacological therapies for prevention and early treatment of acute lung injury. Seminars in Respiratory and Critical Care Medicine. 2013:34(4):448-458. [28]