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A Review of Acute Respiratory Distress Syndrome (ARDS) by George T. Abdallah, PharmD, BCCCP, BCCP

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  • ARDS is characterized by hypoxemia, opacities on chest CT and low lung compliance
  • There are three phases: exudative, proliferative and fibrotic
  • Treatment options include:
    • Low tidal volumes (Tidal volumes of 4 to 8 mL/kg of ideal body weight (IBW)
    • Fluid restriction 
    • Paralytics and prone position can be considered for PaO2/FiO2 < 150
    • ECMO may be reserved as a salvage option in severe cases


  • Gajic O, Dabbagh O, Park PK, Adesanya A, Chang SY, Hou P, Anderson H, Hoth JJ, Mikkelsen ME, Gentile NT, Gong MN, Talmor D, Bajwa E, Watkins TR, Festic E, Yilmaz M, Iscimen R, Kaufman DA, Esper AM, Sadikot R, Douglas I, Sevransky J, Malinchoc M., U.S. Critical Illness and Injury Trials Group: Lung Injury Prevention Study Investigators (USCIITG-LIPS). Early identification of patients at risk of acute lung injury: evaluation of lung injury prediction score in a multicenter cohort study. Am J Respir Crit Care Med. 2011 Feb 15;183(4):462-70. [PMC free article] [PubMed]
  • Wang Y, Zhang L, Xi X, Zhou JX., China Critical Care Sepsis Trial (CCCST) Workgroup. The Association Between Etiologies and Mortality in Acute Respiratory Distress Syndrome: A Multicenter Observational Cohort Study. Front Med (Lausanne). 2021;8:739596. [PMC free article] [PubMed]
  • Zambon M, Vincent JL. Mortality rates for patients with acute lung injury/ARDS have decreased over time. Chest. 2008 May;133(5):1120-7. [PubMed]
  • Shrestha GS, Khanal S, Sharma S, Nepal G. COVID-19: Current Understanding of Pathophysiology. J Nepal Health Res Counc. 2020 Nov 13;18(3):351-359. [PubMed]
  • Sedhai YR, Yuan M, Ketcham SW, Co I, Claar DD, McSparron JI, Prescott HC, Sjoding MW. Validating Measures of Disease Severity in Acute Respiratory Distress Syndrome. Ann Am Thorac Soc. 2021 Jul;18(7):1211-1218. [PMC free article] [PubMed]
  • Sharma NS, Lal CV, Li JD, Lou XY, Viera L, Abdallah T, King RW, Sethi J, Kanagarajah P, Restrepo-Jaramillo R, Sales-Conniff A, Wei S, Jackson PL, Blalock JE, Gaggar A, Xu X. The neutrophil chemoattractant peptide proline-glycine-proline is associated with acute respiratory distress syndrome. Am J Physiol Lung Cell Mol Physiol. 2018 Nov 01;315(5):L653-L661. [PMC free article] [PubMed]
  • Huang D, Ma H, Xiao Z, Blaivas M, Chen Y, Wen J, Guo W, Liang J, Liao X, Wang Z, Li H, Li J, Chao Y, Wang XT, Wu Y, Qin T, Su K, Wang S, Tan N. Diagnostic value of cardiopulmonary ultrasound in elderly patients with acute respiratory distress syndrome. BMC Pulm Med. 2018 Aug 13;18(1):136. [PMC free article] [PubMed]
  • Chen WL, Lin WT, Kung SC, Lai CC, Chao CM. The Value of Oxygenation Saturation Index in Predicting the Outcomes of Patients with Acute Respiratory Distress Syndrome. J Clin Med. 2018 Aug 08;7(8) [PMC free article] [PubMed]
  • Rawal G, Yadav S, Kumar R. Acute Respiratory Distress Syndrome: An Update and Review. J Transl Int Med. 2018 Jun;6(2):74-77. [PMC free article] [PubMed]
  • Cherian SV, Kumar A, Akasapu K, Ashton RW, Aparnath M, Malhotra A. Salvage therapies for refractory hypoxemia in ARDS. Respir Med. 2018 Aug;141:150-158. [PMC free article] [PubMed]
  • Guérin C, Reignier J, Richard JC, Beuret P, Gacouin A, Boulain T, Mercier E, Badet M, Mercat A, Baudin O, Clavel M, Chatellier D, Jaber S, Rosselli S, Mancebo J, Sirodot M, Hilbert G, Bengler C, Richecoeur J, Gainnier M, Bayle F, Bourdin G, Leray V, Girard R, Baboi L, Ayzac L., PROSEVA Study Group. Prone positioning in severe acute respiratory distress syndrome. N Engl J Med. 2013 Jun 06;368(23):2159-68. [PubMed]
  • National Heart, Lung, and Blood Institute PETAL Clinical Trials Network. Moss M, Huang DT, Brower RG, Ferguson ND, Ginde AA, Gong MN, Grissom CK, Gundel S, Hayden D, Hite RD, Hou PC, Hough CL, Iwashyna TJ, Khan A, Liu KD, Talmor D, Thompson BT, Ulysse CA, Yealy DM, Angus DC. Early Neuromuscular Blockade in the Acute Respiratory Distress Syndrome. N Engl J Med. 2019 May 23;380(21):1997-2008. [PMC free article] [PubMed]
  • National Heart, Lung, and Blood Institute Acute Respiratory Distress Syndrome (ARDS) Clinical Trials Network. Wiedemann HP, Wheeler AP, Bernard GR, Thompson BT, Hayden D, deBoisblanc B, Connors AF, Hite RD, Harabin AL. Comparison of two fluid-management strategies in acute lung injury. N Engl J Med. 2006 Jun 15;354(24):2564-75. [PubMed]
  • Brodie D, Bacchetta M. Extracorporeal membrane oxygenation for ARDS in adults. N Engl J Med. 2011 Nov 17;365(20):1905-14. [PubMed]
  • Combes A, Hajage D, Capellier G, Demoule A, Lavoué S, Guervilly C, Da Silva D, Zafrani L, Tirot P, Veber B, Maury E, Levy B, Cohen Y, Richard C, Kalfon P, Bouadma L, Mehdaoui H, Beduneau G, Lebreton G, Brochard L, Ferguson ND, Fan E, Slutsky AS, Brodie D, Mercat A., EOLIA Trial Group, REVA, and ECMONet. Extracorporeal Membrane Oxygenation for Severe Acute Respiratory Distress Syndrome. N Engl J Med. 2018 May 24;378(21):1965-1975. [PubMed]
  • Yang P, Formanek P, Scaglione S, Afshar M. Risk factors and outcomes of acute respiratory distress syndrome in critically ill patients with cirrhosis. Hepatol Res. 2019 Mar;49(3):335-343. [PMC free article] [PubMed]
  • Gadre SK, Duggal A, Mireles-Cabodevila E, Krishnan S, Wang XF, Zell K, Guzman J. Acute respiratory failure requiring mechanical ventilation in severe chronic obstructive pulmonary disease (COPD). Medicine (Baltimore). 2018 Apr;97(17):e0487. [PMC free article] [PubMed]
  • Chiumello D, Coppola S, Froio S, Gotti M. What’s Next After ARDS: Long-Term Outcomes. Respir Care. 2016 May;61(5):689-99. [PubMed]
  • Villar J, Schultz MJ, Kacmarek RM. The LUNG SAFE: a biased presentation of the prevalence of ARDS! Crit Care. 2016 Apr 25;20(1):108. [PMC free article] [PubMed]
  • Bos LD, Cremer OL, Ong DS, Caser EB, Barbas CS, Villar J, Kacmarek RM, Schultz MJ., MARS consortium. External validation confirms the legitimacy of a new clinical classification of ARDS for predicting outcome. Intensive Care Med. 2015 Nov;41(11):2004-5. [PubMed]