The acute respiratory distress syndrome: a clinical review
The acute respiratory distress syndrome (ARDS), is characterized by bilateral pulmonary infiltrates with refractory hypoxemia that is non-cardiogenic in origin, and has a high incidence in hospitalized patients with a significant mortality rate. Much effort has gone into understanding more about the disease including providing a definition that is standardized in order to aid in early diagnosis and treatment. In this review we provide a clinical overview of our current knowledge about the epidemiology, pathophysiology, and treatment recommendations in ARDS. We will focus on current recommended low tidal volume ventilation strategies, different approaches to optimizing positive end expiratory pressure (PEEP), optimal fluid management, and utility of auxiliary medications. Specific areas addressed include ventilator strategies to avoid further injury to the lung, appropriate use of neuromuscular blockade and pronation, as well the current role of advanced therapies such as ECMO. Finally, we will review the goal of future research to focus on prevention of the disease in a multidisciplinary fashion.