title: Acute respiratory distress syndrome following cardiovascular surgery: current concepts and novel therapeutic approaches.
abstract: OBJECTIVE
  This review gives an update on current treatment options and novel concepts on the prevention and treatment of the acute respiratory distress syndrome (ARDS) in cardiovascular surgery patients.
  
  
  RESULTS
  The only proven beneficial therapeutic options in ARDS are those that help to prevent further ventilator-induced lung injury, such as prone position, use of lung-protective ventilation strategies, and extracorporeal membrane oxygenation. In the future also new approaches like mesenchymal cell therapy, activation of hypoxia-elicited transcription factors or targeting of purinergic signaling may be successful outside the experimental setting. Owing to the so far limited treatment options, it is of great importance to determine patients at risk for developing ARDS already perioperatively. In this context, serum biomarkers and lung injury prediction scores could be useful.
  
  
  CONCLUSIONS
  Preventing ARDS as a severe complication in the cardiovascular surgery setting may help to reduce morbidity and mortality. As cardiovascular surgery patients are of greater risk to develop ARDS, preventive interventions should be implemented early on. Especially, use of low tidal volumes, avoiding of fluid overload and restrictive blood transfusion regimes may help to prevent ARDS.
authors.affiliation: aOrgan Protection Program, Department of Anesthesiology, University of Colorado School of Medicine, Aurora, Colorado, USA bDepartment of Anesthesiology and Comprehensive Pneumology Center Munich (CPC-M), German Center for Lung Research, University Hospital, Ludwig-Maximilians-University, Munich, Germany cDepartment of Pediatrics, University of Colorado School of Medicine, Aurora, Colorado, USA.
authors.forename: Sandra
authors.initials: S
authors.lastname: Hoegl
authors.forename: Bernhard
authors.initials: B
authors.lastname: Zwissler
authors.forename: Holger K
authors.initials: HK
authors.lastname: Eltzschig
authors.forename: Christine
authors.initials: C
authors.lastname: Vohwinkel
mesh_terms: D013504:Cardiovascular Surgical Procedures / Q000009:adverse effects*; D006801:Humans; D011183:Postoperative Complications / Q000628:therapy*; D012121:Respiration, Artificial / Q000009:adverse effects; D012128:Respiratory Distress Syndrome / Q000209:etiology* / Q000628:therapy*; D055397:Ventilator-Induced Lung Injury / Q000517:prevention & control / Q000628:therapy