title: Diagnostic workup for ARDS patients.
abstract: Acute respiratory distress syndrome (ARDS) is defined by the association of bilateral infiltrates and hypoxaemia following an initial insult. Although a new definition has been recently proposed (Berlin definition), there are various forms of ARDS with potential differences regarding their management (ventilator settings, prone positioning use, corticosteroids). ARDS can be caused by various aetiologies, and the adequate treatment of the responsible cause is crucial to improve the outcome. It is of paramount importance to characterize the mechanisms causing lung injury to optimize both the aetiological treatment and the symptomatic treatment. If there is no obvious cause of ARDS or if a direct lung injury is suspected, bronchoalveolar lavage (BAL) should be strongly considered to identify microorganisms responsible for pneumonia. Blood samples can also help to identify microorganisms and to evaluate biomarkers of infection. If there is no infectious cause of ARDS or no other apparent aetiology is found, second-line examinations should include markers of immunologic diseases. In selected cases, open lung biopsy remains useful to identify the cause of ARDS when all other examinations remain inconclusive. CT scan is fundamental when there is a suspicion of intra-abdominal sepsis and in some cases of pneumonia. Ultrasonography is important not only in evaluating biventricular function but also in identifying pleural effusions and pneumothorax. The definition of ARDS remains clinical and the main objective of the diagnostic workup should be to be focused on identification of its aetiology, especially a treatable infection.
authors.affiliation: Assistance Publique - Hôpitaux de Marseille, Hôpital Nord, Réanimation des Détresses Respiratoires et des Infections Sévères, 13015, Marseille, France. laurent.papazian@ap-hm.fr.|Aix-Marseille Université, Faculté de médecine, URMITE UMR CNRS 7278, 13005, Marseille, France. laurent.papazian@ap-hm.fr.
authors.forename: Laurent
authors.initials: L
authors.lastname: Papazian
authors.affiliation: Departments of Medicine and Anesthesia, Cardiovascular Research Institute, University of California San Francisco, San Francisco, CA, USA.
authors.forename: Carolyn S
authors.initials: CS
authors.lastname: Calfee
authors.affiliation: Dipartimento di Anestesia, Rianimazione ed Emergenza-Urgenza, Fondazione IRCCS Ca' Granda - Ospedale Maggiore Policlinico, Milan, Italy.|Dipartimento di Fisiopatologia Medico-Chirurgica e dei Trapianti, Università degli Studi di Milano, Milan, Italy.
authors.forename: Davide
authors.initials: D
authors.lastname: Chiumello
authors.affiliation: Service de Réanimation, Institut de Cardiologie, Groupe Hospitalier Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, Paris, France.|Sorbonne Universités, UPMC Université Paris 06, INSERM, UMRS 1166-ICAN Institute of Cardiometabolism and Nutrition, Paris, France.
authors.forename: Charles-Edouard
authors.initials: CE
authors.lastname: Luyt
authors.affiliation: Pulmonary, Allergy, and Critical Care Division, University of Pennsylvania, Perelman School of Medicine, Philadelphia, PA, USA.
authors.forename: Nuala J
authors.initials: NJ
authors.lastname: Meyer
authors.affiliation: Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN, USA.
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Sekiguchi
authors.affiliation: Departments of Medicine and Anesthesia, Cardiovascular Research Institute, University of California San Francisco, San Francisco, CA, USA.
authors.forename: Michael A
authors.initials: MA
authors.lastname: Matthay
authors.affiliation: Division of Pulmonary Critical Care, and Sleep Medicine, Departments of Medicine, Memphis Veterans Affairs Medical Center, Memphis, TN, USA.
authors.forename: Gianfranco Umberto
authors.initials: GU
authors.lastname: Meduri
mesh_terms: D015415:Biomarkers / Q000097:blood; D001706:Biopsy; D003937:Diagnosis, Differential; D003952:Diagnostic Imaging; D006801:Humans; D010641:Phenotype; D057285:Precision Medicine; D012128:Respiratory Distress Syndrome / Q000175:diagnosis* / Q000209:etiology*
chemical_list: D015415:Biomarkers
keywords: ARDS; BAL; CT scan; Diffuse alveolar damage; Personalized medicine; Phenotype–endotype; Ultrasonography