title: Current Concepts of ARDS: A Narrative Review.
abstract: Acute respiratory distress syndrome (ARDS) is characterized by the acute onset of pulmonary edema of non-cardiogenic origin, along with bilateral pulmonary infiltrates and reduction in respiratory system compliance. The hallmark of the syndrome is refractory hypoxemia. Despite its first description dates back in the late 1970s, a new definition has recently been proposed. However, the definition remains based on clinical characteristic. In the present review, the diagnostic workup and the pathophysiology of the syndrome will be presented. Therapeutic approaches to ARDS, including lung protective ventilation, prone positioning, neuromuscular blockade, inhaled vasodilators, corticosteroids and recruitment manoeuvres will be reviewed. We will underline how a holistic framework of respiratory and hemodynamic support should be provided to patients with ARDS, aiming to ensure adequate gas exchange by promoting lung recruitment while minimizing the risk of ventilator-induced lung injury. To do so, lung recruitability should be considered, as well as the avoidance of lung overstress by monitoring transpulmonary pressure or airway driving pressure. In the most severe cases, neuromuscular blockade, prone positioning, and extra-corporeal life support (alone or in combination) should be taken into account.
authors.affiliation: Unità Operativa Complessa di Anestesia e Rianimazione, Ospedale San Paolo-Azienda Socio Sanitaria Territoriale Santi Paolo e Carlo, 20124 Milano, Italy. michele.umbrello@fastwebnet.it.
authors.forename: Michele
authors.initials: M
authors.lastname: Umbrello
authors.affiliation: Unità Operativa Complessa di Anestesia e Rianimazione, Ospedale San Paolo-Azienda Socio Sanitaria Territoriale Santi Paolo e Carlo, 20124 Milano, Italy. formenti.paolo80@gmail.com.
authors.forename: Paolo
authors.initials: P
authors.lastname: Formenti
authors.affiliation: Dipartimento di Scienze della Salute, Università degli Studi di Milano, 20124 Milano, Italy. luca.bolgiaghi@hotmail.it.
authors.forename: Luca
authors.initials: L
authors.lastname: Bolgiaghi
authors.affiliation: Unità Operativa Complessa di Anestesia e Rianimazione, Ospedale San Paolo-Azienda Socio Sanitaria Territoriale Santi Paolo e Carlo, 20124 Milano, Italy. davide.chiumello@unimi.it.|Dipartimento di Scienze della Salute, Università degli Studi di Milano, 20124 Milano, Italy. davide.chiumello@unimi.it.
authors.forename: Davide
authors.initials: D
authors.lastname: Chiumello
mesh_terms: D006801:Humans; D008168:Lung / Q000000981:diagnostic imaging / Q000382:microbiology / Q000473:pathology; D012121:Respiration, Artificial / Q000379:methods; D012128:Respiratory Distress Syndrome / Q000175:diagnosis* / Q000382:microbiology / Q000628:therapy; D012129:Respiratory Function Tests / Q000379:methods
keywords: acute respiratory distress syndrome; critically ill patients; lung-protective ventilation; positive end-expiratory pressure