Synopsis of Clinical Acute Respiratory Distress Syndrome (ARDS)

The entity of acute respiratory distress syndrome (ARDS) is an acute inflammatory lung condition associated with lung damage and increased vascular permeability. In the ICU, ARDS was reported to be the cause of 10.4% of admissions. The syndrome is associated with conditions such as sepsis, burns, trauma, and many others. The Berlin Definition which is the most up-to-date definition defines ARDS as an early onset of severe and refractory hypoxemia, PaO2/FiO(2) ratio less than 300 mmHg, bilateral infiltrates on chest x-ray, and alveolar edema not explained by a cardiogenic cause or fluid overload. The entity of ARDS and its treatment have been studied for many years to better understand it and help find therapies. However, the mainstay of medical management is supportive with specific strategies for mechanical ventilation. No specific drug therapy is available at present. In this chapter, the history, clinical picture, and therapeutic approaches to ARDS will be discussed. We include lung-protective ventilation, prone positioning, use of neuromuscular blockade, corticosteroids, as well as discussion of studies done on this important clinical and morbid condition. We emphasize that there are ongoing trials and research being done to better identify patients earlier in their clinical course so that supportive care with lung-protective ventilation and a conservative fluid approach can be implemented. We also mention promising therapies such as cellbased therapies which would help in decreasing lung inflammation.