Critical care clinics
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Critical care clinics · Oct 2021
ReviewThe Epidemiology of Acute Respiratory Distress Syndrome Before and After Coronavirus Disease 2019.
Acute respiratory distress syndrome (ARDS) is a heterogeneous syndrome of high morbidity and mortality with global impact. Current epidemiologic estimates are imprecise given differences in patient populations, risk factors, resources, and practice styles around the world. Despite improvement in supportive care which has improved mortality, effective targeted therapies remain elusive. ⋯ Intensive care unit rates of death have varied widely in studies to date because of a variety of patient and hospital-level factors. Despite some controversy, the best management of these patients is likely the same supportive measures shown to be effective in classical ARDS. Further epidemiologic studies are needed to help characterize the epidemiology of ARDS subphenotypes to facilitate identification of targeted therapies.
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Critical care clinics · Oct 2021
ReviewCOVID-19-Associated Acute Respiratory Distress Syndrome: Lessons from Tissues and Cells.
Reports examining lung histopathology in coronavirus disease 2019 (COVID-19) infection provide an essential body of information for clinicians and investigators. Severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2)-induced lung injury is complex, involving the airways, alveoli, and pulmonary vessels. ⋯ The biological and molecular mechanisms that drive this pattern of injury are unknown, and the relationship of SARS-CoV-2-induced DAD to physiologic alterations and clinical outcomes in COVID-19-associated acute respiratory distress syndrome is undefined. Additional histologic patterns that may be variant phenotypes have been reported.
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Critical care clinics · Oct 2021
ReviewLong-Term Outcomes in Acute Respiratory Distress Syndrome: Epidemiology, Mechanisms, and Patient Evaluation.
Survivors of acute respiratory distress syndrome (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 coronavirus disease 2019 pandemic is drastically increasing the incidence of ARDS worldwide, and long-term impairments will remain lasting effects of the pandemic. Evaluation of the ARDS survivor should be comprehensive, and common domains of impairment that have emerged from long-term outcomes research over the past 2 decades should be systematically evaluated.
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Critical care clinics · Oct 2021
ReviewPathophysiology 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 etiologic insults, and consequently it is associated with a multitude of pathophysiological abnormalities. Despite more than 50 years of experimental studies, translation of these benchside discoveries into effective biological therapies has been elusive. In this review, some of the key advances made in our knowledge of the pathophysiology of ARDS, based on histopathology, imaging, protein, and transcriptomic biomarkers, are presented. Finally, the role of such human studies in understanding the pathophysiology of coronavirus disease 2019-related ARDS is reviewed.
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Critical care clinics · Oct 2021
ReviewPharmacologic Treatments for Acute Respiratory Distress Syndrome.
Acute respiratory distress syndrome is a heterogenous syndrome with many etiologies for which there are no definitive pharmacologic treatments, despite decades of research. We explore some adjunctive pharmacologic therapies, including neuromuscular blockade, corticosteroids, and inhaled pulmonary vasodilators. ⋯ We do discuss the potential role of steroids in acute respiratory distress syndrome with severe acute respiratory syndrome coronavirus 2 as a trigger. The standard of care, however, remains supportive care.