Pathophysiology and Management of Acute Respiratory Distress Syndrome in Obese Patients

2019 ◽  
Vol 40 (01) ◽  
pp. 040-056 ◽  
Author(s):  
Michele Umbrello ◽  
Jacopo Fumagalli ◽  
Antonio Pesenti ◽  
Davide Chiumello
Keyword(s):  
Acute Respiratory Distress Syndrome ◽  
Respiratory Distress Syndrome ◽  
Respiratory Distress ◽  
Distress Syndrome ◽  
Imaging Techniques ◽  
Treatment Options ◽  
Public Health Problem ◽  
Optimal Strategies ◽  
Current Evidence ◽  
Important Public Health Problem

AbstractA rising prevalence of obesity is reported over time and throughout the world. At the same time, the acute respiratory distress syndrome (ARDS) remains an important public health problem, accounting for approximately 10% of intensive care unit admissions and leading to significant hospital mortality. Even in the absence of acute illnesses, obesity affects respiratory mechanics and gas exchange in the setting of a restrictive disease. In the presence of ARDS, obesity adds various challenges to a safe and effective management of respiratory support. Difficult airway management, altered lung and chest wall physiology, and positional gas trapping are routinely encountered. The management of such difficult cases is generally empiric, as it is based on small-sized, physiologic studies or on suggestions from the general anesthesia literature. The present review focuses on those cases in which ARDS is coincident with obesity, with the aim of presenting treatment options based on the current evidence. The first part summarizes the epidemiology of obesity and ARDS. Then the diagnostic challenges due to obesity-related artifacts of the different imaging techniques will be presented. A subsequent, detailed description of the altered respiratory anatomy and physiology of obesity will provide help in selecting an optimal, individually tailored strategy of support. Furthermore, we will discuss how esophageal manometry should be used to adjust the settings of positive end-expiratory pressure and tidal volume; the challenges of prone positioning and extracorporeal support; and the optimal strategies for weaning from mechanical ventilation, including when and how to perform a tracheostomy.

scholarly journals Precision medicine in acute respiratory distress syndrome: workshop report and recommendations for future research

2021 ◽  
Vol 30 (159) ◽  
pp. 200317 ◽  
Author(s):  
Lieuwe D.J. Bos ◽  
Antonio Artigas ◽  
Jean-Michel Constantin ◽  
Laura A. Hagens ◽  
Nanon Heijnen ◽  
...  
Keyword(s):  
Acute Respiratory Distress Syndrome ◽  
Respiratory Distress Syndrome ◽  
Respiratory Distress ◽  
Precision Medicine ◽  
Distress Syndrome ◽  
Current Evidence ◽  
Future Research ◽  
European Respiratory Society ◽  
Therapeutic Trials ◽  
Wide Range

Acute respiratory distress syndrome (ARDS) is a devastating critical illness that can be triggered by a wide range of insults and remains associated with a high mortality of around 40%. The search for targeted treatment for ARDS has been disappointing, possibly due to the enormous heterogeneity within the syndrome. In this perspective from the European Respiratory Society research seminar on “Precision medicine in ARDS”, we will summarise the current evidence for heterogeneity, explore the evidence in favour of precision medicine and provide a roadmap for further research in ARDS. There is evident variation in the presentation of ARDS on three distinct levels: 1) aetiological; 2) physiological and 3) biological, which leads us to the conclusion that there is no typical ARDS. The lack of a common presentation implies that intervention studies in patients with ARDS need to be phenotype aware and apply a precision medicine approach in order to avoid the lack of success in therapeutic trials that we faced in recent decades. Deeper phenotyping and integrative analysis of the sources of variation might result in identification of additional treatable traits that represent specific pathobiological mechanisms, or so-called endotypes.

Acute Respiratory Distress Syndrome

2005 ◽  
Vol 18 (2) ◽  
pp. 118-131 ◽  
Author(s):  
Brian S. Burleson ◽  
Erik D. Maki
Keyword(s):  
Acute Respiratory Distress Syndrome ◽  
Respiratory Distress Syndrome ◽  
Respiratory Distress ◽  
Distress Syndrome ◽  
Inflammatory Responses ◽  
Treatment Options ◽  
Clinical Trial Design ◽  
Severe Form ◽  
Consensus Definition ◽  
Definition Of

Acute lung injury is a syndrome diagnosed clinically and is one of the most common causes of respiratory failure seen in the intensive care unit. A consensus definition of this and its more severe form, acute respiratory distress syndrome (ARDS), has allowed for better consistency in determining the epidemiology and facilitates consistent clinical trial design to better find therapies to treat or prevent it. Patients who present with ARDS usually show signs of tachpnea or dyspnea and have underlying conditions that promote inflammatory responses. The pathogenesis involves an inflammatory insult that eventually destroys the pulmonary capillary vasculature as well as alveoli. Pathophysiologically, the patient with ARDS may progress through as many as 3 phases: exudative, proliferative, and fibrotic. Treatment options can be either nonpharmacologic or pharmacologic and are limited. Ventilator strategies such as low-tidal-volume ventilation have improved outcomes in these patients, while corticosteroid use is not as established to provide morbidity or mortality benefit. Other therapies have been investigated with inconclusive or disappointing results for the treatment of this fatal syndrome.

scholarly journals Imagining of Acute Respiratory Distress Syndrome: A Review

2021 ◽  
pp. 55-61
Author(s):  
Hossam A. El-Kenawy ◽  
Abdullah Thamer Aldarsouny ◽  
Nouf Mohammed Alaqel ◽  
Noor Anwar S. Alkhamis ◽  
Fatimah Fayez J Aldawood ◽  
...  
Keyword(s):  
Acute Respiratory Distress Syndrome ◽  
Respiratory Distress Syndrome ◽  
Respiratory Distress ◽  
Distress Syndrome ◽  
Treatment Options ◽  
Low Oxygen ◽  
Life Threatening Illness ◽  
Imaging Results ◽  
Life Threatening ◽  
Bilateral Lung

Acute respiratory distress syndrome (ARDS) is a life-threatening disorder marked by low oxygen levels and rigid or non-compliant lungs. In the absence of any indication of cardiogenic pulmonary edema, ARDS is defined as an acute disease that begins within 7 days of the triggering event and is marked by bilateral lung infiltrates and severe progressive hypoxemia. ARDS has a significant death rate, and there are few effective treatment options for this life-threatening illness. The management of these severely ill patients in the intensive care unit relies heavily on imaging. Chest radiography, bedside lung ultrasonography, and computed tomography scans can all help with patient care and prognostic variables identification. However, imaging results are not always specific, and other diagnosis should be considered.

scholarly journals Emerging Mechanisms of Pulmonary Vasoconstriction in SARS-CoV-2-Induced Acute Respiratory Distress Syndrome (ARDS) and Potential Therapeutic Targets

2020 ◽  
Vol 21 (21) ◽  
pp. 8081 ◽  
Author(s):  
Harry Karmouty-Quintana ◽  
Rajarajan A. Thandavarayan ◽  
Steven P. Keller ◽  
Sandeep Sahay ◽  
Lavannya M. Pandit ◽  
...  
Keyword(s):  
Acute Respiratory Distress Syndrome ◽  
Respiratory Distress Syndrome ◽  
Respiratory Distress ◽  
Distress Syndrome ◽  
Vascular Dysfunction ◽  
Treatment Options ◽  
Renin Angiotensin System ◽  
Respiratory Illness ◽  
1918 Influenza ◽  
Novel Coronavirus

The 1918 influenza killed approximately 50 million people in a few short years, and now, the world is facing another pandemic. In December 2019, a novel coronavirus named severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has caused an international outbreak of a respiratory illness termed coronavirus disease 2019 (COVID-19) and rapidly spread to cause the worst pandemic since 1918. Recent clinical reports highlight an atypical presentation of acute respiratory distress syndrome (ARDS) in COVID-19 patients characterized by severe hypoxemia, an imbalance of the renin–angiotensin system, an increase in thrombogenic processes, and a cytokine release storm. These processes not only exacerbate lung injury but can also promote pulmonary vascular remodeling and vasoconstriction, which are hallmarks of pulmonary hypertension (PH). PH is a complication of ARDS that has received little attention; thus, we hypothesize that PH in COVID-19-induced ARDS represents an important target for disease amelioration. The mechanisms that can promote PH following SARS-CoV-2 infection are described. In this review article, we outline emerging mechanisms of pulmonary vascular dysfunction and outline potential treatment options that have been clinically tested.

The Promise of Mesenchymal stem cells therapy for acute Respiratory Distress Syndrome Caused by COVID-19

2020 ◽  
Vol 15 ◽  
Author(s):  
Jundong Gu ◽  
Qinjun Zhao ◽  
Zhibo Han ◽  
Zhongchao Han
Keyword(s):  
Stem Cells ◽  
Acute Respiratory Distress Syndrome ◽  
Respiratory Distress Syndrome ◽  
Respiratory Distress ◽  
Distress Syndrome ◽  
Public Health Problem ◽  
Preclinical Models ◽  
The World ◽  
Stem Cells Therapy ◽  
General Mortality

: The outbreak of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) since Dec 2019, known as COVID-19 or 19-nCoV, has led to a major concern of the potential for not only an epidemic but a pandemic in China and now it seems to be a public health problem all over the world. The general mortality rate of the COVID-19 was about 3%. However, the mortality risk seems to be a significant increase in elderly and cases with chronic disease, who are more likely to develop into acute respiratory distress syndrome (ARDS). There still lacks effective methods for ARDS of COVID-19 patients and the prognosis was poor. Mesenchyma stem cells (MSCs) based treatment has the advantage of targeting numerous pathophysiological components of ARDS by secreting a series of cell factors, exerting anti-inflammatory, antioxidative, immunomodulatory, antiapoptotic, and proangiogenic effects, resulting in significant structural and functional recovery following ARDS in various preclinical models. And recently pilot clinical studies indicated MSCs based therapy was promise in treatment of ARDS caused by SARS-CoV-2. However, little is known about MSCs therapy for ARDS caused by COVID-19.

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