title: The acute respiratory distress syndrome.
abstract: The acute respiratory distress syndrome (ARDS) is a major cause of acute respiratory failure. Its development leads to high rates of mortality, as well as short- and long-term complications, such as physical and cognitive impairment. Therefore, early recognition of this syndrome and application of demonstrated therapeutic interventions are essential to change the natural course of this devastating entity. In this review article, we describe updated concepts in ARDS. Specifically, we discuss the new definition of ARDS, its risk factors and pathophysiology, and current evidence regarding ventilation management, adjunctive therapies, and intervention required in refractory hypoxemia.
authors.affiliation: Division of Pulmonary and Critical Care Medicine, Baylor University Medical Center at Dallas, Dallas, Texas (Modrykamien), and the Division of Pulmonary, Sleep, and Critical Care Medicine, Creighton University Medical Center, Omaha, Nebraska (Gupta).
authors.forename: Ariel M
authors.initials: AM
authors.lastname: Modrykamien
authors.affiliation: Division of Pulmonary and Critical Care Medicine, Baylor University Medical Center at Dallas, Dallas, Texas (Modrykamien), and the Division of Pulmonary, Sleep, and Critical Care Medicine, Creighton University Medical Center, Omaha, Nebraska (Gupta).
authors.forename: Pooja
authors.initials: P
authors.lastname: Gupta
references.citation: Chest. 2000 Jan;117(1):163-8
references.pmid: 10631215
references.citation: Intensive Care Med. 1998 Apr;24(4):378-98
references.pmid: 9609420
references.citation: Respir Care. 2008 Nov;53(11):1441-9
references.pmid: 18957146
references.citation: J Trauma. 2007 Aug;63(2):344-50
references.pmid: 17693834
references.citation: Am J Respir Crit Care Med. 2001 Nov 1;164(9):1701-11
references.pmid: 11719313
references.citation: Crit Care Med. 2003 Apr;31(4 Suppl):S265-71
references.pmid: 12682451
references.citation: Crit Care Med. 2009 Aug;37(8):2455-64
references.pmid: 19531947
references.citation: Am J Respir Crit Care Med. 1994 Mar;149(3 Pt 1):818-24
references.pmid: 7509706
references.citation: Intensive Care Med. 2010 Apr;36(4):585-99
references.pmid: 20130832
references.citation: Lancet. 2007 May 5;369(9572):1553-64
references.pmid: 17482987
references.citation: Intensive Care Med. 2002 Dec;28(12):1742-9
references.pmid: 12447517
references.citation: N Engl J Med. 2006 Jun 15;354(24):2564-75
references.pmid: 16714767
references.citation: Crit Care Med. 1997 Jan;25(1):28-32
references.pmid: 8989172
references.citation: Am J Respir Crit Care Med. 1998 Jan;157(1):294-323
references.pmid: 9445314
references.citation: Crit Care Med. 1991 Oct;19(10):1234-41
references.pmid: 1914479
references.citation: Am J Respir Crit Care Med. 2011 Feb 15;183(4):462-70
references.pmid: 20802164
references.citation: Crit Care Med. 2003 Mar;31(3):869-77
references.pmid: 12626999
references.citation: N Engl J Med. 2005 Oct 20;353(16):1685-93
references.pmid: 16236739
references.citation: Thorax. 2011 Jan;66(1):66-73
references.pmid: 20980246
references.citation: Am Rev Respir Dis. 1988 Sep;138(3):720-3
references.pmid: 3202424
references.citation: Intensive Care Med. 2002 Apr;28(4):406-13
references.pmid: 11967593
references.citation: Ann Intern Med. 2009 Oct 20;151(8):566-76
references.pmid: 19841457
references.citation: JAMA. 2012 Jun 20;307(23):2526-33
references.pmid: 22797452
references.citation: Crit Care Med. 2006 Mar;34(3):738-44
references.pmid: 16521268
references.citation: N Engl J Med. 2006 Apr 27;354(17 ):1775-86
references.pmid: 16641394
references.citation: N Engl J Med. 2010 Sep 16;363(12):1107-16
references.pmid: 20843245
references.citation: Am J Respir Crit Care Med. 2000 Feb;161(2 Pt 1):432-9
references.pmid: 10673182
references.citation: Intensive Care Med. 2011 Sep;37(9):1447-57
references.pmid: 21732167
references.citation: N Engl J Med. 2013 Feb 28;368(9):806-13
references.pmid: 23339638
references.citation: N Engl J Med. 2013 Jun 6;368(23):2159-68
references.pmid: 23688302
references.citation: Eur Respir J. 2012 Aug;40(2):291-3
references.pmid: 22855467
references.citation: JAMA. 2008 Feb 13;299(6):646-55
references.pmid: 18270353
references.citation: JAMA. 2010 Mar 3;303(9):865-73
references.pmid: 20197533
references.citation: Thorax. 2010 Jan;65(1):44-50
references.pmid: 19770169
references.citation: Chest. 1999 Jul;116(1 Suppl):9S-15S
references.pmid: 10424561
references.citation: Arch Surg. 1985 May;120(5):536-40
references.pmid: 3885915
references.citation: Cleve Clin J Med. 2011 Feb;78(2):101-10
references.pmid: 21285342
references.citation: Anesthesiology. 1997 Aug;87(2):297-307
references.pmid: 9286894
references.citation: Am J Respir Crit Care Med. 1998 Feb;157(2):387-93
references.pmid: 9476848
references.citation: Lancet. 1967 Aug 12;2(7511):319-23
references.pmid: 4143721
references.citation: N Engl J Med. 1993 Feb 11;328(6):399-405
references.pmid: 8357359
references.citation: Intensive Care Med. 1997 Aug;23(8):819-35
references.pmid: 9310799
references.citation: N Engl J Med. 2004 Jul 22;351(4):327-36
references.pmid: 15269312
references.citation: Curr Opin Crit Care. 2005 Feb;11(1):43-9
references.pmid: 15659944
references.citation: Crit Care Med. 2002 Aug;30(8):1679-85
references.pmid: 12163776
references.citation: Am J Respir Crit Care Med. 2008 Dec 1;178(11):1156-63
references.pmid: 18776154
references.citation: Crit Care Med. 2006 Jan;34(1):22-30
references.pmid: 16374152
references.citation: Crit Care Med. 2002 Nov;30(11):2450-6
references.pmid: 12441753
references.citation: Am J Respir Crit Care Med. 2002 Sep 15;166(6):801-8
references.pmid: 12231488
references.citation: Intensive Care Med. 2000 May;26(5):526-31
references.pmid: 10923725
references.citation: Intensive Care Med. 2004 Jan;30(1):51-61
references.pmid: 14569423
references.citation: Crit Care Med. 1997 Sep;25(9):1539-44
references.pmid: 9295829
references.citation: Chest. 1987 Dec;92(6):1032-6
references.pmid: 3315478
references.citation: JAMA. 1995 Jan 25;273(4):306-9
references.pmid: 7815658
references.citation: N Engl J Med. 2000 May 4;342(18):1301-8
references.pmid: 10793162
references.citation: Chest. 2011 Feb;139(2):289-95
references.pmid: 20688925
references.citation: Intensive Care Med. 2008 Jan;34(1):61-9
references.pmid: 18000649
references.citation: Am Rev Respir Dis. 1988 Jul;138(1):62-8
references.pmid: 3202402
references.citation: Am J Respir Crit Care Med. 2007 Oct 15;176(8):761-7
references.pmid: 17656676
references.citation: Am J Respir Crit Care Med. 2001 Jul 1;164(1):43-9
references.pmid: 11435237
references.citation: Am J Respir Crit Care Med. 2011 Jun 15;183(12):1660-5
references.pmid: 21471091
references.citation: Crit Care Med. 2004 Nov;32(11 Suppl):S554-61
references.pmid: 15542964
references.citation: Intensive Care Med. 2003 Feb;29(2):218-25
references.pmid: 12536272
references.citation: Chest. 2007 Apr;131(4):954-63
references.pmid: 17426195
references.citation: JAMA. 1979 Nov 16;242(20):2193-6
references.pmid: 490805
references.citation: Am J Respir Crit Care Med. 2005 Feb 1;171(3):242-8
references.pmid: 15557131
references.citation: N Engl J Med. 2013 Feb 28;368(9):795-805
references.pmid: 23339639
references.citation: Chest. 1987 Jun;91(6):850-4
references.pmid: 3556054
references.citation: N Engl J Med. 1987 Dec 17;317(25):1565-70
references.pmid: 3317054
references.citation: Neth J Med. 2005 Nov;63(10):382-92
references.pmid: 16301759
references.citation: J Biomech. 2009 May 29;42(8):1108-13
references.pmid: 19345364
references.citation: Crit Care Med. 2008 May;36(5):1518-22
references.pmid: 18434908
references.citation: Intensive Care Med. 1997 Oct;23(10):1033-9
references.pmid: 9407238
references.citation: Chest. 1997 May;111(5):1334-9
references.pmid: 9149591
references.citation: BMJ. 2007 Apr 14;334(7597):779
references.pmid: 17383982
references.citation: Am J Respir Crit Care Med. 2002 Feb 15;165(4):443-8
references.pmid: 11850334
references.citation: Ann Intern Med. 2002 Jan 1;136(1):25-36
references.pmid: 11777361
references.citation: N Engl J Med. 2006 Apr 20;354(16):1671-84
references.pmid: 16625008
references.citation: Crit Care Med. 2008 Jun;36(6):1937-49
references.pmid: 18496365
references.citation: JAMA. 1998 Jul 8;280(2):159-65
references.pmid: 9669790
references.citation: Chest. 2003 Nov;124(5):1871-9
references.pmid: 14605062
references.citation: Crit Care Med. 2003 Nov;31(11):2592-7
references.pmid: 14605529
references.citation: Lancet. 2009 Oct 17;374(9698):1351-63
references.pmid: 19762075
references.citation: Crit Care Med. 2004 Mar;32(3):787-94
references.pmid: 15090963
references.citation: JAMA. 2009 Nov 11;302(18):1977-84
references.pmid: 19903918
references.citation: N Engl J Med. 2001 Aug 23;345(8):568-73
references.pmid: 11529210
references.citation: Intensive Care Med. 2006 Oct;32(10):1627-31
references.pmid: 16874497
references.citation: JAMA. 2008 Feb 13;299(6):637-45
references.pmid: 18270352
references.citation: Am J Respir Crit Care Med. 2006 Jun 1;173(11):1233-9
references.pmid: 16556697
references.citation: Crit Care Med. 2005 Mar;33(3 Suppl):S135-41
references.pmid: 15753719
references.citation: JAMA. 1996 Jan 3;275(1):50-4
references.pmid: 8531287
references.citation: Crit Care Med. 2000 Jul;28(7):2187-92
references.pmid: 10921539
references.citation: JAMA. 2004 Nov 17;292(19):2379-87
references.pmid: 15547166
references.citation: Am J Respir Crit Care Med. 1999 Apr;159(4 Pt 1):1241-8
references.pmid: 10194172
references.citation: J Appl Physiol (1985). 1993 Jul;75(1):206-16
references.pmid: 8376266
references.citation: Crit Care Med. 2008 Feb;36(2):603-9
references.pmid: 18216609
references.citation: Am J Respir Crit Care Med. 2001 Sep 1;164(5):795-801
references.pmid: 11549535