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REVIEW ARTICLE
Year : 2018  |  Volume : 131  |  Issue : 10  |  Page : 1220-1224

Acute Respiratory Distress Syndrome: Challenge for Diagnosis and Therapy


Department of Critical Care Medicine, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, Jiangsu 210009, China

Correspondence Address:
Dr. Hai-Bo Qiu
Department of Critical Care Medicine, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, Jiangsu 210009
China
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0366-6999.228765

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Objective: Acute respiratory distress syndrome (ARDS) is a devastating clinical syndrome whose diagnosis and therapy are still in question. The aim of this review was to discuss the current challenge for the diagnosis and treatment of ARDS. Data Sources: Data sources were the published articles in English through December 2017 in PubMed using the following key words: “acute respiratory distress syndrome,” “definition”, “diagnosis,” “therapy,” “lung protective strategy,” “right ventricular dysfunction,” and “molecular mechanism.” Study Selection: The selection of studies focused on both preclinical studies and clinical studies of therapy of ARDS. Results: The incidence of ARDS is still high, and ARDS causes high intensive care units admissions and high mortality. The Berlin Definition proposed in 2012 is still controversial owing to lack of sensitivity and specificity. ARDS is still under recognition and it is associated with high mortality. Lung protective strategies with low tidal volume (VT) and lung recruitment should consider the physiology of ARDS because ARDS presents lung inhomogeneity; the same low VT might increase local stress and strain in some patients with low compliance, and lung recruitment could injure lungs in ARDS patients with low recruitability and hemodynamic instability. Acute cor pulmonale is common in severe ARDS. ARDS itself and some treatments could worsen acute cor pulmonale. Molecular understanding of the pathogenic contributors to ARDS has improved, but the molecular-associated treatments are still under development. Conclusions: ARDS is a devastating clinical syndrome whose incidence and mortality has remained high over the past 50 years. Its definition and treatments are still confronted with challenges, and early recognition and intervention are crucial for improving the outcomes of ARDS. More clinical studies are needed to improve early diagnosis and appropriate therapy.

 

 Abstract in Chinese

急性呼吸窘迫综合征:面临的挑战

摘要

目的:急性呼吸窘迫综合征(ARDS)是临床常见的危重症,往往导致患者预后不良,然而,ARDS的诊断与治疗仍面临很多的困难。本综述就目前ARDS在诊疗过程中面临的挑战与困境进行讨论。

数据来源:以“急性呼吸窘迫综合征”、“定义”、“诊断”、“治疗”、“肺保护性通气”、“右心功能障碍”和“分子机制” 为关键词在Pubmed上搜索截止到2017年12月的相关英文文献。

研究选择:入选的文章必须涉及ARDS治疗进展的临床前与临床研究。

结果:目前ARDS的发病率、ICU住院率及病死率仍较高。尽管ARDS柏林诊断标准提出已经近5年,但这一诊断仍存在争议,对ARDS诊断的敏感性和特异性仍不高。临床对于ARDS的诊断仍不够及时和准确,而这往往导致ARDS不良预后。小潮气量及肺复张为基础的肺保护性通气需要基于患者的病理生理变化,由于ARDS的不均一性,同样的潮气量会导致局部应力及应变的增加,而且对于低可复张或血流动力学不稳定的患者,肺复张往往会加重肺损伤并导致循环进一步的恶化。对于重度ARDS,急性肺心病是常见的合并症,并且患者的病情及临床的一些不适当的干预治疗往往会导致患者急性肺心病的加重。分子生物学的进步有助于深入理解ARDS病理生理变化,但是分子层面的治疗仍需要进一步的研究证实。

结论:虽然ARDS的发现距今已经有50年,但目前的发病率及病死率仍较高,而且目前的诊断和治疗仍面临巨大的挑战,早期诊断和干预能够改善ARDS的临床预后,但需要更多的临床证据优化诊疗措施。



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