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Acute Respiratory Distress Syndrome

Acute Respiratory Distress Syndrome (ARDS): Definition, Incidence, and OutcomeDefinition of ARDSFrom the First Clinical Description to the First Consensus Definition of ARDSThe Current Berlin DefinitionWhat Are the Limitations of the Current Definition?Incidence and Outcome of ARDSHas Mortality Decreased Over Time?How Can We Explain the Lack of Improvement in Outcome in ARDS?Causes of Death and Subphenotypes in Patients with ARDSLong-Term OutcomeConclusionReferencesPathophysiology of Acute Respiratory 2 Distress SyndromeIntroductionPathophysiology of Acute Respiratory Distress Syndrome: The ActorsAlveolar MacrophagesNeutrophilsAlveolar EpitheliumAlveolar EndotheliumPulmonary Versus Extrapulmonary ARDS: The Myth Is a FactARDS PhenotypesSeptic and Cancer PhenotypesTrauma and Transfusion PhenotypesFuture Perspectives for Translation of Experimental Models into TherapyConclusionReferencesVentilation Strategies: Tidal Volume and PEEPIntroductionRespiratory System Structural Dysfunction After ARDSTidal Volume and PEEP During Spontaneous Ventilatory Support in ARDS PatientsInvasive Mechanical Ventilation in ARDS Patients: Role of Tidal VolumeLimiting the Tidal Volumes in ARDS with Modern VentilatorsLow Tidal Volumes Must Generate Low Driving Pressures to Assure It Is Really Protective to ARDS PatientsInvasive Mechanical Ventilation in ARDS Patients: Role of End-Positive Expiratory Pressure (PEEP) LevelsInteraction Between Low Tidal Volume and High PEEP Levels During Invasive Mechanical Ventilation in ARDS PatientsReferencesVentilation Strategies: High-Frequency Oscillatory VentilationIntroductionMechanisms of Gas Transport and ExchangeBulk ConvectionMolecular DiffusionAsymmetric Velocity ProfilesTaylor DispersionPendelluft PhenomenaCardiogenic MixingCollateral VentilationPrinciples of Non-injurious Mechanical Ventilation and HFOV SettingsProtection of the LungsProtection of the RVComplications of HFOVAdjunctive Therapies to HFOVClinical Evidence for the Use of HFOVReferencesVentilation Strategies: Recruitment ManeuversIntroductionPhysiology of Recruitment ManeuversDefinition and RationaleConsequences and SafetyTechniques of Recruitment ManeuversSighSustained InflationSlow Stepwise ManeuversEvaluation of Recruitment Maneuver EffectsBlood Gas Analysis and PaO2/FiO2 RatioCompliance and Pressure-Volume CurveComputed TomographyLung UltrasoundElectrical Impedance TomographyConclusionsBibliographyProne Position IntroductionPhysiological EffectsOxygenationRespiratory MechanicsLung Protection from VILIPatient OutcomeSurvivalWhy Survival Goes Up with the Prone Position in the Most Severely Hypoxemic Patients?Clinical PracticeReferencesPartial or Total Extracorporeal Support IntroductionPrinciples of VV-ECMOComponents of ECMO CircuitPhysiology of VV-ECMOOxygen Delivery During VV-ECMOEffect of VV-ECMO on CO2 RemovalCannulation and Cannula Configurations for VV-ECMOAnticoagulationECMO for ARDS: A Historical PerspectiveIndications to VV-ECMOTotal Respiratory Extracorporeal SupportTechnical RequirementsWhat Is Refractory Hypoxaemia? Who Are the Candidates for Rescue ECMO Support?The Natural Lung Maintenance During Total Respiratory ECMOManagement of Persistent Severe Hypoxaemia During VV-ECMOComplications and Limits of Total Extracorporeal SupportPartial Extracorporeal SupportTechniques for Partial Extracorporeal SupportPartial Extracorporeal Support for Protective Ventilatory Strategies in ARDSReferencesHemodynamic Monitoring and Fluid Management in ARDSIntroductionPathophysiologyAdverse Effects of Fluid OverloadBenefits of Fluid RestrictionFluid Measurement and MonitoringMeasurement of Pulmonary EdemaClinicalExtravascular Lung WaterPulmonary Vascular Permeability IndexUltrasoundHemodynamic MonitoringGeneral Principles/StrategiesStatic ParametersDynamic Parameters Pulse Pressure VariationRespiratory Variation of the Inferior Vena CavaFluid ChallengeThe Passive Leg-Raising ManeuverEVLW as a Therapeutic TargetFluid Restriction and Edema ClearancePractical ConsiderationsEnhancing Edema ClearanceModulation of Oncotic PressurePharmacologic TherapiesGeneral Paradigm for Resuscitation in ARDSConclusionReferencesWeaning in ARDS QIntroductionDefinitionsRoutine WeaningProgress Toward WeaningWeaning Criteria AssessmentSpontaneous Breathing TrialsWeaning ProtocolMovement to Spontaneous BreathingBarriers to WeaningIncreased Respiratory LoadDecreased Respiratory DriveExcess Sedation and AnalgesiaCardiac LoadMuscle Atrophy and WeaknessMetabolic Electrolyte and Endocrine ConsiderationsPsychological DysfunctionConsent, Compliance, and ComfortAdjunctive CareMonitoringTherapy and MobilizationTracheostomyExtubation to Noninvasive VentilationAdaptive and Automated Weaning Systems (AWS)SummaryReferencesLung Imaging in ARDS IntroductionDiagnostic AssessmentChest X-RayComputed TomographyLung UltrasoundPositron Emission TomographyElectrical Impedance TomographyMagnetic Resonance ImagingRecruitmentComputed TomographyLung UltrasoundElectrical Impedance TomographyOverdistensionComputed TomographyLung PerfusionComputed TomographyElectrical Impedance TomographyTechnical Advantages and LimitationsChest X-RayComputed TomographyLung UltrasoundPositron Emission TomographyElectrical Impedance TomographyMagnetic Resonance ImagingFrom Bedside to the Radiology Department: Risks of Patient's TransportReferencesAcute Respiratory Distress Syndrome: Metabolic SupportStress Response and Critically Ill Patients' Metabolic RequirementsConsequences of Acute Respiratory Failure on Patients' Stress ReactionCharacteristic Features of Artificial Nutrition in Acute Respiratory FailurePhysiologic Effects of Substrate MetabolismThe Determinants of Energy ConsumptionDiet-Induced Termogenesis (DIT)Disposal, Transformation, and Storage of NutrientsResting Energy ExpenditurePossible Adverse Effects of Single Macronutrient on the Lung Tissue of Patients with ARDSCarbohydrates and LipidsProteinsPeculiar Characteristics of Metabolic Control of Critically Ill Patients with ARDSConclusionsReferencesPharmacological Interventions: Neuromuscular Blocking AgentsIntroductionClinical Practice and Historical ContextRandomized Controlled TrialsSummary of the Evidence-Based Data and LimitationsPhysiopathologyShort-Term Effects of NMBAsPathophysiological Hypothesis of the Beneficial Effects of NMBAsDeleterious Effects of Spontaneous Breathing in the Acute Phase of ARDSAdverse EventsNMBAS and ICU-Acquired Weakness (ICUAW)Insufficient Sedation and MemorizingPerspectives: The Appropriate Place of NMBAs in ARDS TreatmentReferencesVentilator-Induced Lung Injury IntroductionThe Concept of VILIFactors Related to Development of VILILung-Dependent Factors of VILI: Stress, Strain, and Stress RaisersVentilator-Dependent FactorsBarotrauma and VolutraumaAtelectrauma and PEEP EffectsBiotraumaMechanical PowerExtra-Parenchymal FactorsReferencesMonitoring of Respiratory MechanicsIntroductionModeling Respiratory MechanicsMethods for Assessing Respiratory MechanicsStatic MethodsMultiple Occlusion TechniqueLow-Flow Inflation TechniqueDynamic MethodsAssessment of "Active" ComponentsMeasurement IssuesTracheal PressureEsophageal PressureAbdominal PressureLung VolumeReferencesNoninvasive Ventilatory Support in Acute Respiratory Distress SyndromeIntroductionStandard of Care for Ventilation Strategy of ARDSRationale, Benefits, and Risks of Using NIV in ARDSWhat Do the Observational Studies Tell Us?What Are the Expected Benefits?NIV Could Delay the Timing of IntubationNIV Cannot Counteract an Injurious Breathing PatternClinical Studies Assessing NIV in ARDSNIV as an Alternative to Invasive Mechanical VentilationNIV as a Prophylactic Ventilator SupportWhen NIV Should Not Be Used in Acute Hypoxemic Respiratory FailureRecommendations for clinical practiceRationale, Benefits, and Risks of High-Flow Oxygenation Through Nasal Cannula in ARDSNoninvasive Ventilator Support in Immunocompromised Patients with ARDSNIV in Immunocompromised PatientsHigh-Flow Nasal Cannula in Immunocompromised Patients with Acute Hypoxemic Respiratory FailureConclusionReferencesInteraction Between the Heart and Lungs IntroductionH-L Interactions: The Impact of Cardiorespiratory System CharacteristicsH-L Interactions in Spontaneous VentilationH-L Interactions in Positive Pressure VentilationH-L Interaction May Be Affected by Underlying ConditionsClinical Implications of H-L Interaction in the ARDS PatientConclusionsReferencesStem Cells and Their Immunomodulatory Potential for the Treatment of ARDSIntroductionMesenchymal Stem/Stromal Cell (MSCs)Performance of MSCs in Preclinical Models of ALI and Translation to Clinical TrialsEnhancing Tissue-Endogenous Stem/Progenitor Cell ActivitySecretion of Paracrine FactorsRegulation of Genes That Modulate the Response to Injury and RepairTransfer of Cellular and Genomic Contents such as Mitochondria and MicroRNAsSummary and Future DirectionsReferencesSedation IntroductionThe Key Importance of Continuous Neurological Assessment with Validated ToolsSedation AssessmentSedation Assessment with Objective MethodsSedation Assessment with Subjective MethodsChoosing and Implementing an Evaluation ScaleClinical Practice Flowcharts for Pain, Agitation, and Delirium ManagementSedation Protocols Presented in LiteratureSpecial CircumstancesReferencesAcute Respiratory Distress Syndrome in ChildrenIntroductionEpidemiology of Paediatric ARDSA New Definition for ARDS in ChildrenPathobiology of Paediatric ARDSMechanical Ventilation for Paediatric ARDSExtracorporeal Life SupportPulmonary Specific Treatment of PARDSExogenous SurfactantNitric OxideCorticosteroidsOther Pharmacological TherapiesNon-pharmacological InterventionsProne PositioningEndotracheal SuctioningChest PhysiotherapyNon-pulmonary Specific TreatmentSedationNeuromuscular BlockadeFluid ManagementTransfusionMonitoring of PARDSOutcome of Paediatric ARDSConclusionsReferencesPulmonary Infections in Acute Respiratory Distress SyndromeIntroductionIncidenceMorbidity and MortalityPathogenesisThe Endotracheal Tube and Pulmonary AspirationOropharyngeal ColonizationGastrointestinal TractOther Risk FactorsEtiologic AgentsPreventionPatient Transport and SedationExtracorporeal Membrane Oxygenation and Tracheal ExtubationDiagnosisTreatmentConclusionsReferences
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