Acute Respiratory Distress Syndrome - Acute Respiratory Distress Syndrome -

Acute Respiratory Distress Syndrome (ARDS): Definition, Incidence, and Outcome Definition of ARDS From the First Clinical Description to the First Consensus Definition of ARDS The Current Berlin Definition What Are the Limitations of the Current Definition?Incidence and Outcome of ARDS Has Mortality Decreased Over Time?How Can We Explain the Lack of Improvement in Outcome in ARDS?Causes of Death and Subphenotypes in Patients with ARDS Long-Term Outcome Conclusion References Pathophysiology of Acute Respiratory 2 Distress Syndrome Introduction Pathophysiology of Acute Respiratory Distress Syndrome: The Actors Alveolar Macrophages Neutrophils Alveolar Epithelium Alveolar Endothelium Pulmonary Versus Extrapulmonary ARDS: The Myth Is a Fact ARDS Phenotypes Septic and Cancer Phenotypes Trauma and Transfusion Phenotypes Future Perspectives for Translation of Experimental Models into Therapy Conclusion References Ventilation Strategies: Tidal Volume and PEEP Introduction Respiratory System Structural Dysfunction After ARDS Tidal Volume and PEEP During Spontaneous Ventilatory Support in ARDS Patients Invasive Mechanical Ventilation in ARDS Patients: Role of Tidal Volume Limiting the Tidal Volumes in ARDS with Modern Ventilators Low Tidal Volumes Must Generate Low Driving Pressures to Assure It Is Really Protective to ARDS Patients Invasive Mechanical Ventilation in ARDS Patients: Role of End-Positive Expiratory Pressure (PEEP) Levels Interaction Between Low Tidal Volume and High PEEP Levels During Invasive Mechanical Ventilation in ARDS Patients References Ventilation Strategies: High-Frequency Oscillatory Ventilation Introduction Mechanisms of Gas Transport and Exchange Bulk Convection Molecular Diffusion Asymmetric Velocity Profiles Taylor Dispersion Pendelluft Phenomena Cardiogenic Mixing Collateral Ventilation Principles of Non-injurious Mechanical Ventilation and HFOV Settings Protection of the Lungs Protection of the RV Complications of HFOV Adjunctive Therapies to HFOV Clinical Evidence for the Use of HFOV References Ventilation Strategies: Recruitment Maneuvers Introduction Physiology of Recruitment Maneuvers Definition and Rationale Consequences and Safety Techniques of Recruitment Maneuvers Sigh Sustained Inflation Slow Stepwise Maneuvers Evaluation of Recruitment Maneuver Effects Blood Gas Analysis and PaO2/FiO2 Ratio Compliance and Pressure-Volume Curve Computed Tomography Lung Ultrasound Electrical Impedance Tomography Conclusions Bibliography Prone Position Introduction Physiological Effects Oxygenation Respiratory Mechanics Lung Protection from VILI Patient Outcome Survival Why Survival Goes Up with the Prone Position in the Most Severely Hypoxemic Patients?Clinical Practice References Partial or Total Extracorporeal Support Introduction Principles of VV-ECMO Components of ECMO Circuit Physiology of VV-ECMO Oxygen Delivery During VV-ECMO Effect of VV-ECMO on CO2 Removal Cannulation and Cannula Configurations for VV-ECMO Anticoagulation ECMO for ARDS: A Historical Perspective Indications to VV-ECMO Total Respiratory Extracorporeal Support Technical Requirements What Is Refractory Hypoxaemia? Who Are the Candidates for Rescue ECMO Support?The Natural Lung Maintenance During Total Respiratory ECMO Management of Persistent Severe Hypoxaemia During VV-ECMO Complications and Limits of Total Extracorporeal Support Partial Extracorporeal Support Techniques for Partial Extracorporeal Support Partial Extracorporeal Support for Protective Ventilatory Strategies in ARDS References Hemodynamic Monitoring and Fluid Management in ARDS Introduction Pathophysiology Adverse Effects of Fluid Overload Benefits of Fluid Restriction Fluid Measurement and Monitoring Measurement of Pulmonary Edema Clinical Extravascular Lung Water Pulmonary Vascular Permeability Index Ultrasound Hemodynamic Monitoring General Principles/Strategies Static Parameters Dynamic Parameters Pulse Pressure Variation Respiratory Variation of the Inferior Vena Cava Fluid Challenge The Passive Leg-Raising Maneuver EVLW as a Therapeutic Target Fluid Restriction and Edema Clearance Practical Considerations Enhancing Edema Clearance Modulation of Oncotic Pressure Pharmacologic Therapies General Paradigm for Resuscitation in ARDS Conclusion References Weaning in ARDS Q Introduction Definitions Routine Weaning Progress Toward Weaning Weaning Criteria Assessment Spontaneous Breathing Trials Weaning Protocol Movement to Spontaneous Breathing Barriers to Weaning Increased Respiratory Load Decreased Respiratory Drive Excess Sedation and Analgesia Cardiac Load Muscle Atrophy and Weakness Metabolic Electrolyte and Endocrine Considerations Psychological Dysfunction Consent, Compliance, and Comfort Adjunctive Care Monitoring Therapy and Mobilization Tracheostomy Extubation to Noninvasive Ventilation Adaptive and Automated Weaning Systems (AWS)Summary References Lung Imaging in ARDS Introduction Diagnostic Assessment Chest X-Ray Computed Tomography Lung Ultrasound Positron Emission Tomography Electrical Impedance Tomography Magnetic Resonance Imaging Recruitment Computed Tomography Lung Ultrasound Electrical Impedance Tomography Overdistension Computed Tomography Lung Perfusion Computed Tomography Electrical Impedance Tomography Technical Advantages and Limitations Chest X-Ray Computed Tomography Lung Ultrasound Positron Emission Tomography Electrical Impedance Tomography Magnetic Resonance Imaging From Bedside to the Radiology Department: Risks of Patient's Transport References Acute Respiratory Distress Syndrome: Metabolic Support Stress Response and Critically Ill Patients' Metabolic Requirements Consequences of Acute Respiratory Failure on Patients' Stress Reaction Characteristic Features of Artificial Nutrition in Acute Respiratory Failure Physiologic Effects of Substrate Metabolism The Determinants of Energy Consumption Diet-Induced Termogenesis (DIT)Disposal, Transformation, and Storage of Nutrients Resting Energy Expenditure Possible Adverse Effects of Single Macronutrient on the Lung Tissue of Patients with ARDS Carbohydrates and Lipids Proteins Peculiar Characteristics of Metabolic Control of Critically Ill Patients with ARDS Conclusions References Pharmacological Interventions: Neuromuscular Blocking Agents Introduction Clinical Practice and Historical Context Randomized Controlled Trials Summary of the Evidence-Based Data and Limitations Physiopathology Short-Term Effects of NMBAs Pathophysiological Hypothesis of the Beneficial Effects of NMBAs Deleterious Effects of Spontaneous Breathing in the Acute Phase of ARDS Adverse Events NMBAS and ICU-Acquired Weakness (ICUAW)Insufficient Sedation and Memorizing Perspectives: The Appropriate Place of NMBAs in ARDS Treatment References Ventilator-Induced Lung Injury Introduction The Concept of VILI Factors Related to Development of VILI Lung-Dependent Factors of VILI: Stress, Strain, and Stress Raisers Ventilator-Dependent Factors Barotrauma and Volutrauma Atelectrauma and PEEP Effects Biotrauma Mechanical Power Extra-Parenchymal Factors References Monitoring of Respiratory Mechanics Introduction Modeling Respiratory Mechanics Methods for Assessing Respiratory Mechanics Static Methods Multiple Occlusion Technique Low-Flow Inflation Technique Dynamic Methods Assessment of "Active" Components Measurement Issues Tracheal Pressure Esophageal Pressure Abdominal Pressure Lung Volume References Noninvasive Ventilatory Support in Acute Respiratory Distress Syndrome Introduction Standard of Care for Ventilation Strategy of ARDS Rationale, Benefits, and Risks of Using NIV in ARDS What Do the Observational Studies Tell Us?What Are the Expected Benefits?NIV Could Delay the Timing of Intubation NIV Cannot Counteract an Injurious Breathing Pattern Clinical Studies Assessing NIV in ARDS NIV as an Alternative to Invasive Mechanical Ventilation NIV as a Prophylactic Ventilator Support When NIV Should Not Be Used in Acute Hypoxemic Respiratory Failure Recommendations for clinical practice Rationale, Benefits, and Risks of High-Flow Oxygenation Through Nasal Cannula in ARDS Noninvasive Ventilator Support in Immunocompromised Patients with ARDS NIV in Immunocompromised Patients High-Flow Nasal Cannula in Immunocompromised Patients with Acute Hypoxemic Respiratory Failure Conclusion References Interaction Between the Heart and Lungs Introduction H-L Interactions: The Impact of Cardiorespiratory System Characteristics H-L Interactions in Spontaneous Ventilation H-L Interactions in Positive Pressure Ventilation H-L Interaction May Be Affected by Underlying Conditions Clinical Implications of H-L Interaction in the ARDS Patient Conclusions References Stem Cells and Their Immunomodulatory Potential for the Treatment of ARDS Introduction Mesenchymal Stem/Stromal Cell (MSCs)Performance of MSCs in Preclinical Models of ALI and Translation to Clinical Trials Enhancing Tissue-Endogenous Stem/Progenitor Cell Activity Secretion of Paracrine Factors Regulation of Genes That Modulate the Response to Injury and Repair Transfer of Cellular and Genomic Contents such as Mitochondria and MicroRNAs Summary and Future Directions References Sedation Introduction The Key Importance of Continuous Neurological Assessment with Validated Tools Sedation Assessment Sedation Assessment with Objective Methods Sedation Assessment with Subjective Methods Choosing and Implementing an Evaluation Scale Clinical Practice Flowcharts for Pain, Agitation, and Delirium Management Sedation Protocols Presented in Literature Special Circumstances References Acute Respiratory Distress Syndrome in Children Introduction Epidemiology of Paediatric ARDS A New Definition for ARDS in Children Pathobiology of Paediatric ARDS Mechanical Ventilation for Paediatric ARDS Extracorporeal Life Support Pulmonary Specific Treatment of PARDS Exogenous Surfactant Nitric Oxide Corticosteroids Other Pharmacological Therapies Non-pharmacological Interventions Prone Positioning Endotracheal Suctioning Chest Physiotherapy Non-pulmonary Specific Treatment Sedation Neuromuscular Blockade Fluid Management Transfusion Monitoring of PARDS Outcome of Paediatric ARDS Conclusions References Pulmonary Infections in Acute Respiratory Distress Syndrome Introduction Incidence Morbidity and Mortality Pathogenesis The Endotracheal Tube and Pulmonary Aspiration Oropharyngeal Colonization Gastrointestinal Tract Other Risk Factors Etiologic Agents Prevention Patient Transport and Sedation Extracorporeal Membrane Oxygenation and Tracheal Extubation Diagnosis Treatment Conclusions References