An Overview on Acute Respiratory Distress Syndrome (ARDS)

Michael A Matthay^*
*Correspondence: Michael A Matthay, Department of Pulmonology, University Hospital of Cattinara, Trieste,, Italy, Email:

Commentary

Acute Respiratory Distress Syndrome (ARDS) is a major clinical concern in the field of respiratory medicine. ARDS is underdiagnosed, according to a major worldwide multicenter prospective cohort study including 50 nations on five continents, and there is room for improvement in its care. In addition, epidemiological evidence from low-income countries suggests that the present definition of ARDS has to be revised in order to enhance recognition and global clinical outcomes. High ozone levels and low vitamin D plasma concentrations were discovered to be predisposing situations for ARDS, in addition to the wellknown risk factors. Since two recent trials on aspirin and statins failed to lower the incidence in at-risk patients, drug-based preventative treatments remain a big problem. A new disease-modifying drug is awaited: while some recent trials suggested that ARDS patients will have a better prognosis, death and debilitating sequelae remain high among ARDS survivors in intensive care.

Acute respiratory distress syndrome (ARDS) is a noncardiogenic pulmonary edoema that causes dyspnea, tachypnea, and hypoxemia to worsen rapidly. The presence of new or worsening respiratory symptoms within one week of a known injury, significant hypoxemia, bilateral lung opacities on radiography, and the inability to explain respiratory failure by heart failure or fluid overload are all diagnostic criteria. ARDS is hypothesised to develop when a pulmonary or extrapulmonary insult triggers the production of inflammatory mediators, encouraging the buildup of inflammatory cells in the alveoli and disruption of lung microcirculation. Inflammatory cells cause pulmonary edoema, hyaline membrane development, decreased lung compliance, and impaired gas exchange by damaging the vascular endothelium and alveolar epithelium. The majority of cases are linked to pneumonia or sepsis. One out of every ten admissions to intensive care units and one out of every four mechanical ventilations is due to ARDS.

Patients with severe ARDS have an in-hospital death rate of 46 percent to 60 percent. ARDS must frequently be distinguished from pneumonia and congestive heart failure, both of which show indications of fluid overload. Mechanical ventilation, prophylaxis for stress ulcers and venous thromboembolism, nutritional assistance, and therapy of the underlying damage are all part of ARDS treatment. Low tidal volume and strong positive end-expiratory pressure help patients get better results. For some mild and all severe instances, prone positioning is advised. A spontaneous breathing trial is recommended to assess eligibility for ventilator weaning as patients with ARDS improve and the underlying illness improves. Patients who survive ARDS are at risk of losing functional capacity, developing mental illness, and having a lower quality of life; these patients benefit from continued treatment from a primary care physician.

Adults with severe pneumonia and acute respiratory distress syndrome (ARDS) are frequently infected with respiratory viruses. New diagnostic tools, particularly multiplex reverse transcription polymerase chain reaction, have improved the detection of viral respiratory infections in critically ill adults. Adults with ARDS caused by respiratory viruses get supportive therapy comparable to individuals with ARDS caused by other causes. Although antiviral medication is available for some respiratory viral infections, more research is needed to establish which patient groups will benefit from it. ARDS is characterised by acute lung inflammation and increased pulmonary vascular permeability, which leads to hypoxemic respiratory failure and bilateral pulmonary radiographic opacities.

Acute respiratory distress syndrome is linked to a high rate of morbidity and mortality, and therapeutic options are limited. This review summarises the current state of knowledge about the aetiology, pathophysiology, and treatment options for ARDS. There is no particular treatment for the underlying pathophysiological mechanisms of acute respiratory distress syndrome (ARDS) more than fifty years. Supportive therapies such as lung protective breathing, restrictive fluid management, paralysing medications, and prone positioning are all part of the current treatment plan. Despite significant advancements in ARDS treatment over the last five decades, the 45 percent fatality rate among patients with severe ARDS remains unsatisfactory. Topics covered include: This article examines the evolution of the present definition, establishes a pathophysiological mechanism, emphasises current best clinical practise in the treatment of ARDS, provides a brief overview of cutting-edge ARDS research, and concludes with an expert opinion on the matter.

Expert opinions: The primary difficulty in ARDS research nowadays is tailoring the available measurements to specific genotypes. The growing digital revolution will aid in the personalization of ARDS treatment, hence improving survival and quality of life. The failure of pharmacological therapy for ARDS, on the other hand, continues to be a problem in the area. We focus in this Review on future prospects to improve clinical trial design to maximise the possibility of identifying successful pharmacological therapy, in addition to providing a brief recap of recent experience with clinical trials in ARDS. Because of the variability of ARDS, prognostic and predictive enrichment techniques that tailor medicines to specific subgroups of ARDS patients based on severity and biology are required. Physiological, radiological, and biological criteria are used to select patients for phase 2 and 3 trials to reduce variability in ARDS clinical trials. In addition, there is increased interest in designing ARDS preventive clinical studies and initiating early treatment of individuals with acute lung injury before endotracheal intubation is required. Combination therapy, cell-based therapies, and generic pharmacological agents with low-risk profiles that are already in routine clinical use for other clinical reasons are among the intriguing novel methods to treating ARDS that we propose.