Category: Emergency Medicine

Emergency Medicine

Pathophysiology of ARDS and COVID-19 Lung Injury

Acute respiratory distress syndrome (ARDS) is a rapidly developing non-cardiogenic pulmonary edema caused by pulmonary and systemic infections or sterile tissue injuries that evoke a severe lung-damaging host inflammatory response. The lung loses its normal gas exchange efficiency with disruption of the tight permeability characteristics of the alveolar capillary barrier. Interstitial and subsequent alveolar edema lead to alveolar collapse/de-recruitment, reduced lung compliance and greater pulmonary vascular resistance, often with marked regional heterogeneity in severity. Regional heightened stress applied to surrounding normal or less injured lung from edematous and collapsed regions along with associated barotrauma, volutrauma and atelectrauma with mechanical or...

Long-Term Outcomes in Acute Respiratory Distress Syndrome: Epidemiology, Mechanisms, and Patient Evaluation

Survivors of ARDS experience challenges that persist well beyond the time of hospital discharge. Impairment in physical function, cognitive function and mental health are common and may last for years. The current COVID-19 pandemic is drastically increasing the incidence of ARDS worldwide, and long-term impairments will remain lasting effects of the pandemic. The evaluation of the ARDS survivor should be comprehensive and systematically evaluate common domains of impairment that have emerged from long-term outcomes research over the past two decades.

Acute Respiratory Distress Syndrome: Ventilator Management and Rescue Therapies

This review describes the management of mechanical ventilation in patients with acute respiratory distress syndrome, including in those with COVID-19. Low tidal volume ventilation with moderate to high positive end expiratory pressure (PEEP) remains the foundation of an evidence-based approach. We consider strategies for setting PEEP levels, the use of recruitment maneuvers, and the potential role of driving pressure. Rescue therapies including prone positioning and extracorporeal membrane oxygenation are also discussed.

Acute Kidney Injury and Acute Respiratory Distress Syndrome

The most consistent signal for mortality in acute respiratory distress syndrome (ARDS) is multi-organ failure, specifically when it involves the kidneys. Acute kidney injury (AKI) complicates approximately a third of all ARDS cases, and the combination of the two drastically worsens prognosis. Recent advances in ARDS supportive care have led to improved outcomes, however, much less is known on how to prevent and support patients with AKI and ARDS together. Understanding the dynamic relationship between the kidneys and lungs is crucial for the practicing intensivist in order to prevent injury. In this review, we summarize key concepts for the critical...

Pathophysiology of The Acute Respiratory Distress Syndrome: Insights from Clinical Studies

Acute respiratory distress syndrome (ARDS) is a heterogeneous clinical syndrome that manifests secondary to numerous aetiological insults and consequently it is associated with a multitude of pathophysiological abnormalities. Despite over 50 years of experimental studies, translation of these benchside discoveries into effective biological therapies has been elusive. Recent advances in high throughput biological sampling, imaging and advances in data analytics has allowed studying ARDS in human subjects based on pragmatic studies. In this review, we present some of the key advances made in our knowledge of the pathophysiology of ARDS, based on histopathology, imaging, protein and transcriptomic biomarkers. Finally, we...

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