Zespół ostrej niewydolności oddechowej

Zespół ostrej niewydolności oddechowej
Etiologia i przyczyny

Zespół ostrej niewydolności oddechowej (ARDS) to ciężkie, zapalne uszkodzenie płuc prowadzące do zwiększonej przepuszczalności naczyń, obrzęku i niedodmy, skutkujące utratą napowietrzonej tkanki płucnej. Etiologia dzieli się na bezpośrednie (np. zapalenie płuc – 46-48%, aspiracja treści żołądkowej – 29%, stłuczenie płuc – 34%) oraz pośrednie przyczyny (np. sepsa – 25-33%, uraz wielonarządowy – 41%, masywne przetoczenia krwi – 34%). COVID-19 stał się wiodącą przyczyną ARDS, z częstością występowania 32,2% u zakażonych, a rozwój ARDS następuje średnio około 8 dni od objawów. Czynniki ryzyka obejmują zaawansowany wiek, cukrzycę, nadciśnienie, palenie tytoniu, nadużywanie alkoholu oraz predyspozycje genetyczne, a ciężkość choroby oceniana m.in. skalą APACHE koreluje z ryzykiem rozwoju ARDS. Patofizjologia opiera się na zapaleniu i uszkodzeniu śródbłonka oraz nabłonka pęcherzyków, z udziałem mediatorów takich jak TNF, IL-1, IL-6 i IL-8, prowadząc do hipoksemii i zaburzeń wentylacji/perfuzji.

Etiologia Zespołu Ostrej Niewydolności Oddechowej (ARDS)

Podział przyczyn ARDS
Bezpośrednie przyczyny ARDS
Pośrednie przyczyny ARDS
ARDS związany z COVID-19
Heterogenność etiologiczna ARDS
Czynniki ryzyka ARDS
Czynniki fizjologiczne a ARDS
Mechanizmy patofizjologiczne ARDS

Powikłania i rokowanie w ARDS

Znaczenie wczesnego rozpoznania i leczenia ARDS
Kolejne rozdziały

Etiologia Zespołu Ostrej Niewydolności Oddechowej (ARDS)

Zespół ostrej niewydolności oddechowej (ARDS) jest ciężkim stanem klinicznym charakteryzującym się ostrym rozlanym zapalnym uszkodzeniem płuc, które prowadzi do zwiększonej przepuszczalności naczyń płucnych i śródbłonka, obrzęku płuc oraz niedodmy zależnej od grawitacji. Wszystkie te czynniki przyczyniają się do utraty napowietrzonej tkanki płucnej.¹ Chociaż ARDS został po raz pierwszy opisany podczas I wojny światowej jako potencjalnie śmiertelna niewydolność oddechowa, sam termin „zespół ostrej niewydolności oddechowej” został przyjęty dopiero w 1967 roku.²

Podział przyczyn ARDS

Przyczyny ARDS można podzielić na dwie główne kategorie: bezpośrednie uszkodzenie płuc (płucne ARDS) oraz pośrednie uszkodzenie płuc (pozapłucne ARDS). Te dwie etiologiczne podgrupy różnie reagują na wentylację mechaniczną i mogą mieć różną charakterystykę radiologiczną we wczesnej fazie.³ W przypadku bezpośrednich urazów płuc, czynnik uszkadzający początkowo wpływa na nabłonek pęcherzyków płucnych, podczas gdy w przypadku urazów pośrednich, proces zapalny zwykle zaczyna się od uszkodzenia śródbłonka naczyniowego.⁴

Bezpośrednie przyczyny ARDS

Bezpośrednie przyczyny uszkodzenia płuc obejmują stany, które występują w płucach lub bezpośrednio na nie wpływają:⁵

Zapalenie płuc (bakteryjne lub wirusowe, w tym COVID-19) – najczęstsza bezpośrednia przyczyna ARDS, stanowiąca około 46% przypadków⁶⁷
Aspiracja treści żołądkowej do płuc (29% przypadków)⁸
Inhalacja toksycznych substancji (chlor, chloraminy, amoniak, fosgen, tlenki azotu)⁹
Uraz płuc (stłuczenie płuc, 34% przypadków)¹⁰
Zatorowość tłuszczowa¹¹
Tonięcie lub stan bliski utonięciu¹²
Wdychanie dymu podczas pożaru¹³
Transplantacja płuc¹⁴
Toksyczność tlenowa¹⁵

Pośrednie przyczyny ARDS

Pośrednie przyczyny uszkodzenia płuc to stany, które występują w innych częściach ciała, ale ostatecznie prowadzą do uszkodzenia płuc:¹⁶

Sepsa – najczęstsza pośrednia przyczyna ARDS, stanowiąca około 33% przypadków¹⁷¹⁸
Ciężkie urazy ciała (urazy głowy, oparzenia, liczne złamania kości)¹⁹
Masywne przetoczenia krwi (34% przypadków)²⁰
Ostre zapalenie trzustki (25% przypadków)²¹
Krążenie pozaustrojowe (bypass sercowo-płucny)²²
Ostre uszkodzenie płuc związane z transfuzją (TRALI)²³
Zespół cieśni jamy brzusznej²⁴
Przedawkowanie leków (heroina, metadon, propoksyfen, lidokaina)²⁵

Łącznie zapalenie płuc i sepsa stanowią 40-60% wszystkich przypadków ARDS.²⁶²⁷ Warto zauważyć, że w około 20% przypadków ARDS nie udaje się zidentyfikować żadnego czynnika ryzyka.²⁸

ARDS związany z COVID-19

Od czasu pojawienia się koronawirusa SARS-CoV-2 w 2019 roku i późniejszej globalnej pandemii, COVID-19 stał się wiodącą przyczyną ARDS na całym świecie. W Stanach Zjednoczonych w pierwszym roku pandemii (2020) odnotowano pięciokrotny wzrost liczby zgonów związanych z ARDS. Przegląd systematyczny i metaanaliza 11 badań obejmujących 2845 uczestników wykazały, że ogólna częstość występowania ARDS wśród pacjentów z COVID-19 wynosi 32,2%.²⁹

U osób z COVID-19 wirus może przemieszczać się poza górne drogi oddechowe, przechodzić przez płuca i ostatecznie docierać do pęcherzyków płucnych. Gdy to nastąpi, COVID-19 może prowadzić do ARDS, który zazwyczaj rozwija się około ośmiu dni po wystąpieniu początkowych objawów. Pewne czynniki ryzyka zwiększają prawdopodobieństwo rozwoju ARDS u osób z COVID-19, w tym zaawansowany wiek, cukrzyca i wysokie ciśnienie krwi.³⁰

Badania sugerują, że białko otoczki SARS-CoV-2 (2-E) samo w sobie może powodować uszkodzenia podobne do ARDS zarówno in vitro, jak i in vivo. Białko to może działać jako ofensywny czynnik zjadliwości przenoszony przez SARS-CoV-2, prowadząc do silnych odpowiedzi zapalnych i śmierci komórek, co może wyjaśniać kliniczne pogorszenie stanu i zgony.³¹

Heterogenność etiologiczna ARDS

Heterogenność w ARDS doprowadziła do wielu statystycznie negatywnych badań klinicznych. Etiologia jest uważana za ważne źródło heterogenności patogenezy w ARDS, ale wcześniejsze badania zwykle przyjmowały dychotomiczną klasyfikację, taką jak płucny versus pozapłucny ARDS, do jej oceny.³²

Badania wykazały, że istnieje znaczna heterogenność związana z etiologią w ARDS. Zaobserwowano również heterogenność w obrębie ARDS związanego z zapaleniem płuc, gdy porównywano bakteryjne zapalenie płuc z innymi niebakteryjnymi zapaleniami płuc.³³

Różne etiologie ARDS mogą prowadzić do różnych zmian histologicznych i biologicznych w płucach. Na przykład, istnieje znaczna heterogenność wewnątrzgrupowa w ARDS związanym z zapaleniem płuc, co podkreśla znaczenie różnicowania między bakteryjnym a niebakteryjnym zapaleniem płuc związanym z ARDS.³⁴

Czynniki ryzyka ARDS

Oprócz bezpośrednich i pośrednich przyczyn, istnieją pewne czynniki ryzyka, które mogą zwiększać podatność na rozwój ARDS po zdarzeniu inicjującym:³⁵

Zaawansowany wiek³⁶
Płeć żeńska (zauważalna tylko w przypadkach urazów)³⁷
Palenie tytoniu³⁸
Nadużywanie alkoholu³⁹
Przewlekła choroba płuc⁴⁰
Operacja wysokiego ryzyka⁴¹
Narażenie na zanieczyszczenie powietrza⁴²
Predyspozycje genetyczne⁴³

Dla każdej podstawowej przyczyny, coraz cięższy stan choroby, przewidywany przez system oceny ciężkości, taki jak APACHE (Acute Physiology And Chronic Health Evaluation), zwiększa ryzyko rozwoju ARDS.⁴⁴

Czynniki fizjologiczne a ARDS

Kilka fizjologicznych czynników ryzyka, takich jak kwasica krwi, hipoalbuminemia, niska podatność oddechowa i wysoki poziom mleczanów, również zwiększa prawdopodobieństwo rozwoju ARDS.⁴⁵

Badanie przeprowadzone przez Glavana i wsp. badało związek między zmiennością genetyczną genu FAS a podatnością na ALI (ostre uszkodzenie płuc). Badanie zidentyfikowało związki między czterema polimorfizmami pojedynczego nukleotydu a zwiększoną podatnością na ALI. Potrzebne są dalsze badania, aby zbadać rolę FAS w ALI.⁴⁶

Mechanizmy patofizjologiczne ARDS

ARDS jest wynikiem ciężkiego zapalenia. Zapalenie powoduje, że maleńkie naczynia krwionośne w płucach stają się „przeciekające”. Płyn wydostaje się z tych naczyń krwionośnych i dostaje się do pęcherzyków płucnych (alveoli). Gdy pęcherzyki płucne wypełniają się płynem, oddychanie staje się trudne. Płuca nie są w stanie dostarczyć wystarczającej ilości tlenu, aby reszta organizmu mogła funkcjonować prawidłowo.⁴⁷

Uszkodzenie płuc powoduje uwolnienie mediatorów zapalnych, a wykazano, że czynnik martwicy nowotworów, interleukina (IL)-1, IL-6 i IL-8 są szczególnie zaangażowane w ARDS. Neutrofile zaczynają uwalniać toksyczne mediatory, ale zamiast rozwiązać podstawowy, początkowy problem, uwolnione reaktywne formy tlenu i proteazy niszczą śródbłonek naczyń włosowatych i nabłonek pęcherzyków płucnych.⁴⁸

Brak wymiany gazowej z obszarów dotkniętych chorobą prowadzi do przecieku prawo-lewego i hipoksemii. Skrzepy fibryny tworzące niedrożności w mikronaczyniach płucnych prowadzą do niedopasowania wentylacji/perfuzji, co przyczynia się do hipoksemii.⁴⁹

Powikłania i rokowanie w ARDS

ARDS może prowadzić do różnych powikłań, w tym zwłóknienia płuc (fibroza).⁵⁰ Może również spowodować niewydolność narządów z powodu niedoboru tlenu w organach i może prowadzić do śmierci.⁵¹

Czynniki ryzyka śmiertelności obejmują zwiększający się wiek, pogarszającą się niewydolność wielonarządową, obecność chorób współistniejących płucnych i pozapłucnych, wyższy wynik APACHE II oraz kwasicę.⁵²

Przyczyna śmierci różni się między fenotypami zapalnymi sepsy. Niewydolność oddechowa jest najczęstszą przyczyną śmierci w sepsie hipozapalnej, podczas gdy wstrząs krążeniowy jest najczęstszą przyczyną w sepsie hiperzapalnej.⁵³

Większość zgonów związanych z ARDS wynika z niewydolności wielonarządowej.⁵⁴ ARDS nadal wiąże się z wysoką śmiertelnością, wynoszącą od 40 do 50 procent.⁵⁵ Ciężki ARDS ma najgorszą śmiertelność (45%) w porównaniu z łagodnym i umiarkowanym ARDS.⁵⁶

Kategoria przyczyn	Przykłady	Częstość występowania
Bezpośrednie uszkodzenie płuc	Zapalenie płuc (bakteryjne, wirusowe, w tym COVID-19)	46-48%
	Aspiracja treści żołądkowej	29%
	Stłuczenie płuc	34%
	Inhalacja toksycznych substancji	Zmienna
	Tonięcie lub stan bliski utonięciu	Zmienna
Pośrednie uszkodzenie płuc	Sepsa	25-33%
	Uraz wielonarządowy	41%
	Masywne przetoczenia krwi	34%
	Ostre zapalenie trzustki	25%
	Przedawkowanie leków	Zmienna
Czynniki ryzyka	Zaawansowany wiek	–
	Palenie tytoniu	–
	Nadużywanie alkoholu	–
	Przewlekła choroba płuc	–
	Narażenie na zanieczyszczenie powietrza	–
	Predyspozycje genetyczne	–

Znaczenie wczesnego rozpoznania i leczenia ARDS

Rozpoznanie i szybkie leczenie ARDS ma kluczowe znaczenie dla zmniejszenia związanej z nim wysokiej śmiertelności.⁵⁷ Ponieważ nie są znane biomarkery, które mogłyby zdiagnozować ARDS, możliwe do wdrożenia w czasie rzeczywistym ramy klasyfikacji pacjentów, które mogą pomóc w rozróżnieniu między ARDS a niezwiązanymi z ARDS przyczynami niewydolności oddechowej, mogłyby pomóc we wczesnej identyfikacji i potencjalnie zmniejszyć związaną z nimi chorobowość i śmiertelność.⁵⁸

W przypadku, gdy przyczyną ARDS była sepsa, leczenie obejmowałoby antybiotyki, jeśli przyczyną jest infekcja bakteryjna, płyny dożylne (IV) i potencjalnie leki zwane wazopresorami, aby pomóc podnieść ciśnienie krwi.⁵⁹

Istnieją również próby zastosowania danych biologicznych w celu poprawy naszego zrozumienia i leczenia ARDS. Sugeruje się, że materiały biologiczne powinny być idealnie zbierane jako część wszystkich randomizowanych badań klinicznych u pacjentów z ARDS, aby umożliwić testowanie heterogeniczności efektu leczenia w podfenotypach biologicznych.⁶⁰

Obecne leczenie ARDS składa się głównie z opieki wspomagającej – od strategii wentylacji oszczędzających płuca i pronacji aż do wsparcia pozaustrojowym natlenianiem krwi (ECMO) – oraz postępowania z podstawowymi przyczynami.⁶¹

Nie ma określonego leku, który okazał się korzystny w leczeniu ARDS. W tych przypadkach stosuje się wiele leków, w tym leki wpływające na funkcję płuc i zapalenie, a także antybiotyki.⁶²

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Materiały źródłowe

#1 Definition, causes and differential diagnosis of ARDS | Deranged Physiology
https://derangedphysiology.com/main/required-reading/respiratory-intensive-care/Chapter-511/definition-causes-and-differential-diagnosis-ards
Many past paper questions ask about the causes and differential diagnosis of „a diffuse bilateral infiltrate on CXR.” […] ARDS is an acute diffuse, inflammatory lung injury precipitated by a predisposing risk factor such as pneumonia, non-pulmonary infection, trauma, transfusion, burn, aspiration, or shock. […] The resulting injury leads to increased pulmonary vascular and epithelial permeability, lung edema, and gravity-dependent atelectasis, all of which contribute to loss of aerated lung tissue. […] A predisposing risk factor: Eg. pneumonia, non-pulmonary infection, trauma, transfusion, aspiration, or shock. […] Onset must be acute: within 7 days of whatever pathology is thought to be the cause. […] There is no need to exclude heart failure – you can have as much heart failure as you like, so long as its severity is insufficient to by itself explain the bilateral pulmonary infiltrates. […] Idiopathic pneumonia syndrome and ATRA syndrome (nowadays referred to as „differentiation syndrome”) have been added since Question 4 from the second paper of 2015 introduced them into the list of differentials.
#2 Acute respiratory distress syndrome (ARDS) | EBSCO Research Starters
https://www.ebsco.com/research-starters/consumer-health/acute-respiratory-distress-syndrome-ards
The oxygen pressure of this ratio, expressed as PaO2:FiO2, indicates that the initial acute lung injury condition has occurred if its value is less than 300 millimeters of mercury (mmHg). If the oxygen pressure continues to decrease to a value of less than 200 mmHg for this ratio, then the patient is diagnosed with ARDS. […] Death can result if ARDS is untreated because vital organs, such as the brain and kidneys, will stop functioning. […] Although ARDS has been recognized since World War I as a potentially fatal respiratory failure, the specific term acute respiratory distress syndrome was not adopted until 1967.
#3 Acute respiratory distress syndrome | Radiology Reference Article | Radiopaedia.org
https://radiopaedia.org/articles/acute-respiratory-distress-syndrome-1?lang=us
Acute respiratory distress syndrome (ARDS) is a form of acute lung injury and occurs as a result of a severe pulmonary injury that causes alveolar damage heterogeneously throughout the lung. It can either result from a direct pulmonary source or as a response to systemic injury. […] The causes of ARDS can result from a direct lung injury, termed pulmonary ARDS, or extrapulmonary where the triggering insult is outside of the lungs. These two etiological subtypes respond in different ways to mechanical ventilation. Some authors have described distinct early phase radiological appearances between the two. […] Pulmonary causes include fat embolism, drowning, infection (viral pneumonia, bacterial pneumonia), pulmonary irritants (chlorine, chloramines, ammonia, phosgene, oxides of nitrogen), oxygen toxicity, smoke inhalation, disseminated intravascular coagulopathy, aspiration (gastric contents, barium contrast), and thoracic trauma (lung contusion). […] Extrapulmonary causes include systemic inflammation (pancreatitis, burns, trauma, sepsis), neurogenic pulmonary edema, transfusion-related lung injury (TRALI), post-cardiopulmonary bypass, abdominal compartment syndrome, and systemic toxicologic exposures (medications, drugs, bipyridyl herbicides).
#4 Etiology-associated heterogeneity in acute respiratory distress syndrome: a retrospective cohort study | BMC Pulmonary Medicine | Full Text
https://bmcpulmmed.biomedcentral.com/articles/10.1186/s12890-021-01557-9
Different etiologies of ARDS can result in different histological and biological changes in the lungs. […] The etiology of ARDS is considered an important source of heterogeneity; however, previous studies have usually adopted a dichotomous classification to evaluate etiology-associated heterogeneity, such as pulmonary versus extrapulmonary ARDS or sepsis versus non-sepsis ARDS. […] Pneumonia was the leading cause of ARDS (48.4%), followed by extra-pulmonary sepsis (11.6%). […] Our data demonstrated that there was considerable within-group heterogeneity in pneumonia associated ARDS. […] Our data highlight the importance of differentiating between bacterial and non-bacterial pneumonia associated ARDS. […] Etiology of ARDS is one of the clinical factors commonly used for ARDS subgrouping. However, the majority of studies adopt a dichotomous classification for subgrouping, such as pulmonary versus extrapulmonary ARDS or trauma versus non-trauma ARDS. […] Our study findings suggest that there was remarkable etiology-associated heterogeneity in ARDS. Heterogeneity was also observed within pneumonia associated ARDS when bacterial pneumonia was compared with other non-bacterial pneumonia.
#5 Acute Respiratory Distress Syndrome (ARDS) > Fact Sheets > Yale Medicine
https://www.yalemedicine.org/conditions/ards
Though it has become part of a vocabulary around COVID-19, Acute Respiratory Distress Syndrome, or ARDS for short, refers to a type of lung damage that can result from a variety of causes, including illness, trauma, or even as a complication that occurs following certain medical procedures. […] ARDS is always caused by an injury to the lungs, whether from illness or injury, but it can affect people of any age. […] Doctors divide the causes of lung injury that lead to ARDS into two broad categories: direct lung injury and indirect lung injury. Direct lung injuries are those that occur in or directly affect the lungs. Indirect injuries are those that occur elsewhere in the body, yet ultimately end up harming the lungs. […] Conditions that cause direct lung injury include: Pneumonia, Aspiration (inhalation of stomach contents into the lungs), Inhalation of toxic substances, Bruising of the lungs caused by chest trauma, Near-drowning, Fat embolism (when a clot of fat enters the pulmonary circulation), Lung transplantation, Viral infection of the lungs, including by SARS-CoV-2, the coronavirus that causes COVID-19 infection.
#6 Acute Respiratory Distress Syndrome – ARDS • LITFL • CCC Ventilation
https://litfl.com/acute-respiratory-distress-syndrome-ards/
Acute Respiratory Distress Syndrome (ARDS) is an acute diffuse, inflammatory lung injury, leading to increased pulmonary vascular permeability, increased lung weight, and loss of aerated lung tissue with hypoxemia and bilateral radiographic opacities, associated with increased venous admixture, increased physiological dead space and decreased lung compliance. […] Direct risk factors include pneumonia (46%), aspiration of gastric contents (29%), lung contusion (34%), fat embolism, near drowning, inhalational injury, and reperfusion injury. […] Indirect risk factors include non-pulmonary sepsis (25%), multiple trauma (41%), massive transfusion (34%), pancreatitis (25%), and cardiopulmonary bypass.
#7 Etiology-associated heterogeneity in acute respiratory distress syndrome: a retrospective cohort study | BMC Pulmonary Medicine | Full Text
https://bmcpulmmed.biomedcentral.com/articles/10.1186/s12890-021-01557-9
Heterogeneity in acute respiratory distress syndrome (ARDS) has led to many statistically negative clinical trials. Etiology is considered an important source of pathogenesis heterogeneity in ARDS but previous studies have usually adopted a dichotomous classification, such as pulmonary versus extrapulmonary ARDS, to evaluate it. Etiology-associated heterogeneity in ARDS remains poorly described. […] Pneumonia (48.4%) and non-pulmonary sepsis (11.6%) were the two leading causes of ARDS. […] This study showed that there was remarkable etiology-associated heterogeneity in ARDS. […] A wide variety of etiologies, referred to as precipitating risk factors in the literature, can lead to ARDS. […] Pneumonia is the most common etiology of ARDS and accounts for roughly half of all ARDS cases. Other common etiologies include extrapulmonary sepsis, aspiration, noncardiogenic shock, transfusion and trauma.
#8 Acute Respiratory Distress Syndrome – ARDS • LITFL • CCC Ventilation
https://litfl.com/acute-respiratory-distress-syndrome-ards/
Acute Respiratory Distress Syndrome (ARDS) is an acute diffuse, inflammatory lung injury, leading to increased pulmonary vascular permeability, increased lung weight, and loss of aerated lung tissue with hypoxemia and bilateral radiographic opacities, associated with increased venous admixture, increased physiological dead space and decreased lung compliance. […] Direct risk factors include pneumonia (46%), aspiration of gastric contents (29%), lung contusion (34%), fat embolism, near drowning, inhalational injury, and reperfusion injury. […] Indirect risk factors include non-pulmonary sepsis (25%), multiple trauma (41%), massive transfusion (34%), pancreatitis (25%), and cardiopulmonary bypass.
#9 Acute respiratory distress syndrome | Radiology Reference Article | Radiopaedia.org
https://radiopaedia.org/articles/acute-respiratory-distress-syndrome-1?lang=us
Acute respiratory distress syndrome (ARDS) is a form of acute lung injury and occurs as a result of a severe pulmonary injury that causes alveolar damage heterogeneously throughout the lung. It can either result from a direct pulmonary source or as a response to systemic injury. […] The causes of ARDS can result from a direct lung injury, termed pulmonary ARDS, or extrapulmonary where the triggering insult is outside of the lungs. These two etiological subtypes respond in different ways to mechanical ventilation. Some authors have described distinct early phase radiological appearances between the two. […] Pulmonary causes include fat embolism, drowning, infection (viral pneumonia, bacterial pneumonia), pulmonary irritants (chlorine, chloramines, ammonia, phosgene, oxides of nitrogen), oxygen toxicity, smoke inhalation, disseminated intravascular coagulopathy, aspiration (gastric contents, barium contrast), and thoracic trauma (lung contusion). […] Extrapulmonary causes include systemic inflammation (pancreatitis, burns, trauma, sepsis), neurogenic pulmonary edema, transfusion-related lung injury (TRALI), post-cardiopulmonary bypass, abdominal compartment syndrome, and systemic toxicologic exposures (medications, drugs, bipyridyl herbicides).
#10 Acute Respiratory Distress Syndrome – ARDS • LITFL • CCC Ventilation
https://litfl.com/acute-respiratory-distress-syndrome-ards/
Acute Respiratory Distress Syndrome (ARDS) is an acute diffuse, inflammatory lung injury, leading to increased pulmonary vascular permeability, increased lung weight, and loss of aerated lung tissue with hypoxemia and bilateral radiographic opacities, associated with increased venous admixture, increased physiological dead space and decreased lung compliance. […] Direct risk factors include pneumonia (46%), aspiration of gastric contents (29%), lung contusion (34%), fat embolism, near drowning, inhalational injury, and reperfusion injury. […] Indirect risk factors include non-pulmonary sepsis (25%), multiple trauma (41%), massive transfusion (34%), pancreatitis (25%), and cardiopulmonary bypass.
#11 Acute Respiratory Distress Syndrome (ARDS) > Fact Sheets > Yale Medicine
https://www.yalemedicine.org/conditions/ards
Though it has become part of a vocabulary around COVID-19, Acute Respiratory Distress Syndrome, or ARDS for short, refers to a type of lung damage that can result from a variety of causes, including illness, trauma, or even as a complication that occurs following certain medical procedures. […] ARDS is always caused by an injury to the lungs, whether from illness or injury, but it can affect people of any age. […] Doctors divide the causes of lung injury that lead to ARDS into two broad categories: direct lung injury and indirect lung injury. Direct lung injuries are those that occur in or directly affect the lungs. Indirect injuries are those that occur elsewhere in the body, yet ultimately end up harming the lungs. […] Conditions that cause direct lung injury include: Pneumonia, Aspiration (inhalation of stomach contents into the lungs), Inhalation of toxic substances, Bruising of the lungs caused by chest trauma, Near-drowning, Fat embolism (when a clot of fat enters the pulmonary circulation), Lung transplantation, Viral infection of the lungs, including by SARS-CoV-2, the coronavirus that causes COVID-19 infection.
#12 Learn About ARDS | American Lung Association
https://www.lung.org/lung-health-diseases/lung-disease-lookup/ards/learn-about-ards
Acute respiratory distress syndrome (ARDS) occurs when our lungs are severely injured, often by infection or trauma. […] ARDS causes fluid to leak into the lungs, making it difficult to get oxygen into the bloodstream. […] ARDS results from lung injury. The exact nature of the injury is not always clear. Common injuries are: […] Sepsis, a life-threatening condition occurs when your immune system must work aggressively to fight off infection or trauma […] Inhaling harmful substances […] Pneumonia […] Trauma to the head, chest or other areas of the body […] Blood transfusions […] Pancreatitis […] Near drowning. […] While it is not clear who will develop ARDS, certain factors may increase the risk for ARDS including: […] Advanced age […] A history of tobacco use […] A history of alcoholism […] Presence of chronic lung disease […] High-risk surgery.
#13 Azthena logo with the word Azthena
https://www.news-medical.net/health/What-is-Acute-Respiratory-Distress-Syndrome-(ARDS).aspx
The most common causes of ARDS are pneumonia, sepsis, aspiration, and severe trauma. The mortality rate is from 40 to 50 percent. […] Severe pulmonary or systemic infections, following trauma, severe burns, pancreatitis, near-aspiration events, drug reactions, multiple blood transfusions, inhalation injuries, and infection are common causes of ARDS. ARDS is mainly a complication of another illness. […] Other causes include inhalation of vomit or near-drowning episodes, head, chest or other significant injuries, and severe burns. […] Another cause of ARDS is pneumonia, which is the infection of the lungs. The common signs and symptoms include cough, fever, sputum production, chills, and fluid accumulation in the space surrounding the lungs. Bacteria, viruses, and other pathogens may cause infection of the lungs. […] Diffuse alveolar damage (DAD) can follow a large number of precipitating events, including infection, sepsis, trauma, shock, toxic inhalants, drug toxicity, burns, and others.
#14 Acute Respiratory Distress Syndrome (ARDS) > Fact Sheets > Yale Medicine
https://www.yalemedicine.org/conditions/ards
Though it has become part of a vocabulary around COVID-19, Acute Respiratory Distress Syndrome, or ARDS for short, refers to a type of lung damage that can result from a variety of causes, including illness, trauma, or even as a complication that occurs following certain medical procedures. […] ARDS is always caused by an injury to the lungs, whether from illness or injury, but it can affect people of any age. […] Doctors divide the causes of lung injury that lead to ARDS into two broad categories: direct lung injury and indirect lung injury. Direct lung injuries are those that occur in or directly affect the lungs. Indirect injuries are those that occur elsewhere in the body, yet ultimately end up harming the lungs. […] Conditions that cause direct lung injury include: Pneumonia, Aspiration (inhalation of stomach contents into the lungs), Inhalation of toxic substances, Bruising of the lungs caused by chest trauma, Near-drowning, Fat embolism (when a clot of fat enters the pulmonary circulation), Lung transplantation, Viral infection of the lungs, including by SARS-CoV-2, the coronavirus that causes COVID-19 infection.
#15 Acute respiratory distress syndrome | Radiology Reference Article | Radiopaedia.org
https://radiopaedia.org/articles/acute-respiratory-distress-syndrome-1?lang=us
Acute respiratory distress syndrome (ARDS) is a form of acute lung injury and occurs as a result of a severe pulmonary injury that causes alveolar damage heterogeneously throughout the lung. It can either result from a direct pulmonary source or as a response to systemic injury. […] The causes of ARDS can result from a direct lung injury, termed pulmonary ARDS, or extrapulmonary where the triggering insult is outside of the lungs. These two etiological subtypes respond in different ways to mechanical ventilation. Some authors have described distinct early phase radiological appearances between the two. […] Pulmonary causes include fat embolism, drowning, infection (viral pneumonia, bacterial pneumonia), pulmonary irritants (chlorine, chloramines, ammonia, phosgene, oxides of nitrogen), oxygen toxicity, smoke inhalation, disseminated intravascular coagulopathy, aspiration (gastric contents, barium contrast), and thoracic trauma (lung contusion). […] Extrapulmonary causes include systemic inflammation (pancreatitis, burns, trauma, sepsis), neurogenic pulmonary edema, transfusion-related lung injury (TRALI), post-cardiopulmonary bypass, abdominal compartment syndrome, and systemic toxicologic exposures (medications, drugs, bipyridyl herbicides).
#16 Acute Respiratory Distress Syndrome (ARDS) > Fact Sheets > Yale Medicine
https://www.yalemedicine.org/conditions/ards
Conditions that cause indirect lung injury include: Sepsis (the body’s overreaction to an infection that can damage multiple organ systems, including the lungs), Severe trauma to the body (head trauma, burns, multiple bone fractures), Massive blood transfusion, Pancreatitis (inflammation of the pancreas), Cardiopulmonary bypass (heart-lung bypass surgery), Drug overdose. […] Out of these possible causes of lung injury, two of themâsepsis and pneumoniaâmake up 40% to 60% of all ARDS cases. […] In some cases, the virus travels beyond the upper airway, moves through the lungs, and ends up in the alveoli. When this occurs, COVID-19 can lead to ARDS, typically setting in about eight days after the onset of initial symptoms. Certain risk factors increase the likelihood of the development of ARDS in people with COVID-19, including advanced age, diabetes, and high blood pressure.
#17 Acute Respiratory Distress Syndrome: Diagnosis and Management | AAFP
https://www.aafp.org/pubs/afp/issues/2012/0215/p352.html
Acute respiratory distress syndrome is believed to occur when a pulmonary or extrapulmonary insult causes the release of inflammatory mediators, promoting neutrophil accumulation in the microcirculation of the lung. […] Most cases of acute respiratory distress syndrome are associated with pneumonia or sepsis. […] Most cases of ARDS in adults are associated with pulmonary sepsis (46 percent) or nonpulmonary sepsis (33 percent). […] Risk factors include those causing direct lung injury (e.g., pneumonia, inhalation injury, pulmonary contusion) and those causing indirect lung injury (e.g., nonpulmonary sepsis, burns, transfusion-related acute lung injury). […] Recent studies indicate that the incidence of adult acute lung injury and ARDS is 22 to 86 cases per 100,000 person-years and up to 64 cases per 100,000 person-years, respectively. […] Risk factors for mortality include increasing age, worsening multiorgan dysfunction, presence of pulmonary and nonpulmonary comorbidities, higher Acute Physiology and Chronic Health Evaluation (APACHE) II score, and acidosis. […] Most ARDS-related deaths are due to multiorgan failure.
#18 ARDS | Sepsis Alliance
https://www.sepsis.org/sepsisand/ards/
Although several causes can result in ARDS, including trauma or aspiration, the most common cause is sepsis. […] If the cause was sepsis, this treatment would include antibiotics if the cause is a bacterial infection, intravenous (IV) fluids, and possibly medications called vasopressors to help raise your blood pressure.
#19 Acute Respiratory Distress Syndrome (ARDS) > Fact Sheets > Yale Medicine
https://www.yalemedicine.org/conditions/ards
Conditions that cause indirect lung injury include: Sepsis (the body’s overreaction to an infection that can damage multiple organ systems, including the lungs), Severe trauma to the body (head trauma, burns, multiple bone fractures), Massive blood transfusion, Pancreatitis (inflammation of the pancreas), Cardiopulmonary bypass (heart-lung bypass surgery), Drug overdose. […] Out of these possible causes of lung injury, two of themâsepsis and pneumoniaâmake up 40% to 60% of all ARDS cases. […] In some cases, the virus travels beyond the upper airway, moves through the lungs, and ends up in the alveoli. When this occurs, COVID-19 can lead to ARDS, typically setting in about eight days after the onset of initial symptoms. Certain risk factors increase the likelihood of the development of ARDS in people with COVID-19, including advanced age, diabetes, and high blood pressure.
#20 Acute Respiratory Distress Syndrome – ARDS • LITFL • CCC Ventilation
https://litfl.com/acute-respiratory-distress-syndrome-ards/
Acute Respiratory Distress Syndrome (ARDS) is an acute diffuse, inflammatory lung injury, leading to increased pulmonary vascular permeability, increased lung weight, and loss of aerated lung tissue with hypoxemia and bilateral radiographic opacities, associated with increased venous admixture, increased physiological dead space and decreased lung compliance. […] Direct risk factors include pneumonia (46%), aspiration of gastric contents (29%), lung contusion (34%), fat embolism, near drowning, inhalational injury, and reperfusion injury. […] Indirect risk factors include non-pulmonary sepsis (25%), multiple trauma (41%), massive transfusion (34%), pancreatitis (25%), and cardiopulmonary bypass.
#21 Acute Respiratory Distress Syndrome – ARDS • LITFL • CCC Ventilation
https://litfl.com/acute-respiratory-distress-syndrome-ards/
Acute Respiratory Distress Syndrome (ARDS) is an acute diffuse, inflammatory lung injury, leading to increased pulmonary vascular permeability, increased lung weight, and loss of aerated lung tissue with hypoxemia and bilateral radiographic opacities, associated with increased venous admixture, increased physiological dead space and decreased lung compliance. […] Direct risk factors include pneumonia (46%), aspiration of gastric contents (29%), lung contusion (34%), fat embolism, near drowning, inhalational injury, and reperfusion injury. […] Indirect risk factors include non-pulmonary sepsis (25%), multiple trauma (41%), massive transfusion (34%), pancreatitis (25%), and cardiopulmonary bypass.
#22 Acute Respiratory Distress Syndrome (ARDS) > Fact Sheets > Yale Medicine
https://www.yalemedicine.org/conditions/ards
Conditions that cause indirect lung injury include: Sepsis (the body’s overreaction to an infection that can damage multiple organ systems, including the lungs), Severe trauma to the body (head trauma, burns, multiple bone fractures), Massive blood transfusion, Pancreatitis (inflammation of the pancreas), Cardiopulmonary bypass (heart-lung bypass surgery), Drug overdose. […] Out of these possible causes of lung injury, two of themâsepsis and pneumoniaâmake up 40% to 60% of all ARDS cases. […] In some cases, the virus travels beyond the upper airway, moves through the lungs, and ends up in the alveoli. When this occurs, COVID-19 can lead to ARDS, typically setting in about eight days after the onset of initial symptoms. Certain risk factors increase the likelihood of the development of ARDS in people with COVID-19, including advanced age, diabetes, and high blood pressure.
#23 Acute respiratory distress syndrome | Radiology Reference Article | Radiopaedia.org
https://radiopaedia.org/articles/acute-respiratory-distress-syndrome-1?lang=us
Acute respiratory distress syndrome (ARDS) is a form of acute lung injury and occurs as a result of a severe pulmonary injury that causes alveolar damage heterogeneously throughout the lung. It can either result from a direct pulmonary source or as a response to systemic injury. […] The causes of ARDS can result from a direct lung injury, termed pulmonary ARDS, or extrapulmonary where the triggering insult is outside of the lungs. These two etiological subtypes respond in different ways to mechanical ventilation. Some authors have described distinct early phase radiological appearances between the two. […] Pulmonary causes include fat embolism, drowning, infection (viral pneumonia, bacterial pneumonia), pulmonary irritants (chlorine, chloramines, ammonia, phosgene, oxides of nitrogen), oxygen toxicity, smoke inhalation, disseminated intravascular coagulopathy, aspiration (gastric contents, barium contrast), and thoracic trauma (lung contusion). […] Extrapulmonary causes include systemic inflammation (pancreatitis, burns, trauma, sepsis), neurogenic pulmonary edema, transfusion-related lung injury (TRALI), post-cardiopulmonary bypass, abdominal compartment syndrome, and systemic toxicologic exposures (medications, drugs, bipyridyl herbicides).
#24 Acute respiratory distress syndrome | Radiology Reference Article | Radiopaedia.org
https://radiopaedia.org/articles/acute-respiratory-distress-syndrome-1?lang=us
Acute respiratory distress syndrome (ARDS) is a form of acute lung injury and occurs as a result of a severe pulmonary injury that causes alveolar damage heterogeneously throughout the lung. It can either result from a direct pulmonary source or as a response to systemic injury. […] The causes of ARDS can result from a direct lung injury, termed pulmonary ARDS, or extrapulmonary where the triggering insult is outside of the lungs. These two etiological subtypes respond in different ways to mechanical ventilation. Some authors have described distinct early phase radiological appearances between the two. […] Pulmonary causes include fat embolism, drowning, infection (viral pneumonia, bacterial pneumonia), pulmonary irritants (chlorine, chloramines, ammonia, phosgene, oxides of nitrogen), oxygen toxicity, smoke inhalation, disseminated intravascular coagulopathy, aspiration (gastric contents, barium contrast), and thoracic trauma (lung contusion). […] Extrapulmonary causes include systemic inflammation (pancreatitis, burns, trauma, sepsis), neurogenic pulmonary edema, transfusion-related lung injury (TRALI), post-cardiopulmonary bypass, abdominal compartment syndrome, and systemic toxicologic exposures (medications, drugs, bipyridyl herbicides).
#25 Surviving ARDS: A Case of Recurrent âIllicit Drug-Inducedâ ARDS | Smischney | Journal of Medical Cases
https://www.journalmc.org/index.php/JMC/article/view/1571/955
Acute respiratory distress syndrome (ARDS) is a severe manifestation of abnormal pulmonary gas exchange. […] We illustrate potential etiologies relating to the multiple ARDS episodes and the recognition of illicit drug use as one of the pathophysiologic factors of recurrent ARDS. […] Through multiple admissions spanning 3.5 years, the evaluation of the etiologic factors for the patients recurrent hypoxic respiratory failure and ARDS centered on excluding possible congestive heart failure and pulmonary infection. […] Ultimately, since neither congestive heart failure nor an infectious cause was apparent and the patient had rapid clinical improvement, it was determined that the underlying cause of her ARDS was secondary to IV heroin and inhaled crack cocaine use. […] Multiple known causes of initial episodes of ARDS include sepsis, trauma, gastric aspiration and the use of particular drugs (namely salicylates, heroin, methadone, lidocaine and propoxyphene).
#26 Acute Respiratory Distress Syndrome (ARDS) > Fact Sheets > Yale Medicine
https://www.yalemedicine.org/conditions/ards
Conditions that cause indirect lung injury include: Sepsis (the body’s overreaction to an infection that can damage multiple organ systems, including the lungs), Severe trauma to the body (head trauma, burns, multiple bone fractures), Massive blood transfusion, Pancreatitis (inflammation of the pancreas), Cardiopulmonary bypass (heart-lung bypass surgery), Drug overdose. […] Out of these possible causes of lung injury, two of themâsepsis and pneumoniaâmake up 40% to 60% of all ARDS cases. […] In some cases, the virus travels beyond the upper airway, moves through the lungs, and ends up in the alveoli. When this occurs, COVID-19 can lead to ARDS, typically setting in about eight days after the onset of initial symptoms. Certain risk factors increase the likelihood of the development of ARDS in people with COVID-19, including advanced age, diabetes, and high blood pressure.
#27 Acute Hypoxemic Respiratory Failure (AHRF, ARDS) – Critical Care Medicine – Merck Manual Professional Edition
https://www.merckmanuals.com/professional/critical-care-medicine/respiratory-failure-and-mechanical-ventilation/acute-hypoxemic-respiratory-failure-ahrf-ards
Airspace filling in acute hypoxemic respiratory failure (AHRF) may result from […] Increased alveolar capillary permeability, as occurs in any of the conditions predisposing to acute respiratory distress syndrome (ARDS) […] Causes of ARDS may involve direct or indirect lung injury. […] Common causes of direct lung injury are […] pneumonia. […] Common causes of indirect lung injury include […] sepsis. […] Sepsis and pneumonia account for about 60% of cases of ARDS. […] ARDS is a diffuse, inflammatory lung injury that is a cause of AHRF.
#28 Acute Respiratory Distress Syndrome (ARDS): Practice Essentials, Background, Pathophysiology
https://emedicine.medscape.com/article/165139-overview
Since the emergence of severe acute respiratory syndrome coronavirus 2 (SARSCoV2) in 2019 and the subsequent global pandemic, Coronavirus disease 2019 (COVID-19) has become the leading cause of ARDS world-wide. In the United States, there was a five-fold increase in ARDS-related deaths during the first year of the pandemic in 2020. A systematic review and meta-analysis of 11 studies with 2845 participants found an overall pooled ARDS prevalence of 32.2% among patients with COVID-19. […] Multiple risk factors exist for ARDS. Approximately 20% of patients with ARDS have no identified risk factor. ARDS risk factors include sepsis, direct lung injury (most commonly aspiration of gastric contents), systemic illnesses, and injuries. […] Given the number of adult studies, major risk factors associated with the development of ARDS include the following: COVID-19, Bacteremia, Sepsis, Trauma, with or without pulmonary contusion, Fractures, particularly multiple fractures and long bone fractures, Burns, Massive transfusion, Pneumonia, Aspiration, Drug overdose, Near drowning, Postperfusion injury after cardiopulmonary bypass, Pancreatitis, Fat embolism.
#29 Acute Respiratory Distress Syndrome (ARDS): Practice Essentials, Background, Pathophysiology
https://emedicine.medscape.com/article/165139-overview
Since the emergence of severe acute respiratory syndrome coronavirus 2 (SARSCoV2) in 2019 and the subsequent global pandemic, Coronavirus disease 2019 (COVID-19) has become the leading cause of ARDS world-wide. In the United States, there was a five-fold increase in ARDS-related deaths during the first year of the pandemic in 2020. A systematic review and meta-analysis of 11 studies with 2845 participants found an overall pooled ARDS prevalence of 32.2% among patients with COVID-19. […] Multiple risk factors exist for ARDS. Approximately 20% of patients with ARDS have no identified risk factor. ARDS risk factors include sepsis, direct lung injury (most commonly aspiration of gastric contents), systemic illnesses, and injuries. […] Given the number of adult studies, major risk factors associated with the development of ARDS include the following: COVID-19, Bacteremia, Sepsis, Trauma, with or without pulmonary contusion, Fractures, particularly multiple fractures and long bone fractures, Burns, Massive transfusion, Pneumonia, Aspiration, Drug overdose, Near drowning, Postperfusion injury after cardiopulmonary bypass, Pancreatitis, Fat embolism.
#30 Acute Respiratory Distress Syndrome (ARDS) > Fact Sheets > Yale Medicine
https://www.yalemedicine.org/conditions/ards
Conditions that cause indirect lung injury include: Sepsis (the body’s overreaction to an infection that can damage multiple organ systems, including the lungs), Severe trauma to the body (head trauma, burns, multiple bone fractures), Massive blood transfusion, Pancreatitis (inflammation of the pancreas), Cardiopulmonary bypass (heart-lung bypass surgery), Drug overdose. […] Out of these possible causes of lung injury, two of themâsepsis and pneumoniaâmake up 40% to 60% of all ARDS cases. […] In some cases, the virus travels beyond the upper airway, moves through the lungs, and ends up in the alveoli. When this occurs, COVID-19 can lead to ARDS, typically setting in about eight days after the onset of initial symptoms. Certain risk factors increase the likelihood of the development of ARDS in people with COVID-19, including advanced age, diabetes, and high blood pressure.
#31 SARS-CoV-2 envelope protein causes acute respiratory distress syndrome (ARDS)-like pathological damages and constitutes an antiviral target | Cell Research
https://www.nature.com/articles/s41422-021-00519-4
Cytokine storm and multi-organ failure are the main causes of SARS-CoV-2-related death. […] Here we show that the SARS-CoV-2 envelope (2-E) protein alone is able to cause acute respiratory distress syndrome (ARDS)-like damages in vitro and in vivo. […] SARS-CoV-2 infection may trigger an overwhelming inflammatory response, which leads to injuries in multiple organs. […] Our data suggest that 2-E protein alone is able to drive pulmonary congestion and provoke robust immune responses in vitro and in vivo. […] We found that 2-E protein may act as an offensive virulence factor carried by SARS-CoV-2, leading to the robust inflammatory responses and cell death, which may explain the clinical aggravation and death. […] The physiological relevance of the pH sensitivity of 2-E channels is worth investigating further. […] Collectively, these results suggest a broader physiological relevance of 2-E channels in SARS-CoV-2 infection.
#32 Etiology-associated heterogeneity in acute respiratory distress syndrome: a retrospective cohort study | BMC Pulmonary Medicine | Full Text
https://bmcpulmmed.biomedcentral.com/articles/10.1186/s12890-021-01557-9
Heterogeneity in acute respiratory distress syndrome (ARDS) has led to many statistically negative clinical trials. Etiology is considered an important source of pathogenesis heterogeneity in ARDS but previous studies have usually adopted a dichotomous classification, such as pulmonary versus extrapulmonary ARDS, to evaluate it. Etiology-associated heterogeneity in ARDS remains poorly described. […] Pneumonia (48.4%) and non-pulmonary sepsis (11.6%) were the two leading causes of ARDS. […] This study showed that there was remarkable etiology-associated heterogeneity in ARDS. […] A wide variety of etiologies, referred to as precipitating risk factors in the literature, can lead to ARDS. […] Pneumonia is the most common etiology of ARDS and accounts for roughly half of all ARDS cases. Other common etiologies include extrapulmonary sepsis, aspiration, noncardiogenic shock, transfusion and trauma.
#33 Etiology-associated heterogeneity in acute respiratory distress syndrome: a retrospective cohort study | BMC Pulmonary Medicine | Full Text
https://bmcpulmmed.biomedcentral.com/articles/10.1186/s12890-021-01557-9
Different etiologies of ARDS can result in different histological and biological changes in the lungs. […] The etiology of ARDS is considered an important source of heterogeneity; however, previous studies have usually adopted a dichotomous classification to evaluate etiology-associated heterogeneity, such as pulmonary versus extrapulmonary ARDS or sepsis versus non-sepsis ARDS. […] Pneumonia was the leading cause of ARDS (48.4%), followed by extra-pulmonary sepsis (11.6%). […] Our data demonstrated that there was considerable within-group heterogeneity in pneumonia associated ARDS. […] Our data highlight the importance of differentiating between bacterial and non-bacterial pneumonia associated ARDS. […] Etiology of ARDS is one of the clinical factors commonly used for ARDS subgrouping. However, the majority of studies adopt a dichotomous classification for subgrouping, such as pulmonary versus extrapulmonary ARDS or trauma versus non-trauma ARDS. […] Our study findings suggest that there was remarkable etiology-associated heterogeneity in ARDS. Heterogeneity was also observed within pneumonia associated ARDS when bacterial pneumonia was compared with other non-bacterial pneumonia.
#34 Etiology-associated heterogeneity in acute respiratory distress syndrome: a retrospective cohort study | BMC Pulmonary Medicine | Full Text
https://bmcpulmmed.biomedcentral.com/articles/10.1186/s12890-021-01557-9
Different etiologies of ARDS can result in different histological and biological changes in the lungs. […] The etiology of ARDS is considered an important source of heterogeneity; however, previous studies have usually adopted a dichotomous classification to evaluate etiology-associated heterogeneity, such as pulmonary versus extrapulmonary ARDS or sepsis versus non-sepsis ARDS. […] Pneumonia was the leading cause of ARDS (48.4%), followed by extra-pulmonary sepsis (11.6%). […] Our data demonstrated that there was considerable within-group heterogeneity in pneumonia associated ARDS. […] Our data highlight the importance of differentiating between bacterial and non-bacterial pneumonia associated ARDS. […] Etiology of ARDS is one of the clinical factors commonly used for ARDS subgrouping. However, the majority of studies adopt a dichotomous classification for subgrouping, such as pulmonary versus extrapulmonary ARDS or trauma versus non-trauma ARDS. […] Our study findings suggest that there was remarkable etiology-associated heterogeneity in ARDS. Heterogeneity was also observed within pneumonia associated ARDS when bacterial pneumonia was compared with other non-bacterial pneumonia.
#35 Acute Respiratory Distress Syndrome (ARDS): Practice Essentials, Background, Pathophysiology
https://emedicine.medscape.com/article/165139-overview
General risk factors for ARDS have not been prospectively studied using the 1994 EACC criteria. However, several factors appear to increase the risk of ARDS after an inciting event, including advanced age, female sex (noted only in trauma cases), cigarette smoking, and alcohol use. For any underlying cause, increasingly severe illness as predicted by a severity scoring system such as the Acute Physiology And Chronic Health Evaluation (APACHE) increases the risk of development of ARDS. […] A study by Glavan et al examined the association between genetic variations in the FAS gene and ALI susceptibility. The study identified associations between four single nucleotide polymorphisms and increased ALI susceptibility. Further studies are needed to examine the role of FAS in ALI.
#36 Learn About ARDS | American Lung Association
https://www.lung.org/lung-health-diseases/lung-disease-lookup/ards/learn-about-ards
Acute respiratory distress syndrome (ARDS) occurs when our lungs are severely injured, often by infection or trauma. […] ARDS causes fluid to leak into the lungs, making it difficult to get oxygen into the bloodstream. […] ARDS results from lung injury. The exact nature of the injury is not always clear. Common injuries are: […] Sepsis, a life-threatening condition occurs when your immune system must work aggressively to fight off infection or trauma […] Inhaling harmful substances […] Pneumonia […] Trauma to the head, chest or other areas of the body […] Blood transfusions […] Pancreatitis […] Near drowning. […] While it is not clear who will develop ARDS, certain factors may increase the risk for ARDS including: […] Advanced age […] A history of tobacco use […] A history of alcoholism […] Presence of chronic lung disease […] High-risk surgery.
#37 Acute Respiratory Distress Syndrome (ARDS): Practice Essentials, Background, Pathophysiology
https://emedicine.medscape.com/article/165139-overview
General risk factors for ARDS have not been prospectively studied using the 1994 EACC criteria. However, several factors appear to increase the risk of ARDS after an inciting event, including advanced age, female sex (noted only in trauma cases), cigarette smoking, and alcohol use. For any underlying cause, increasingly severe illness as predicted by a severity scoring system such as the Acute Physiology And Chronic Health Evaluation (APACHE) increases the risk of development of ARDS. […] A study by Glavan et al examined the association between genetic variations in the FAS gene and ALI susceptibility. The study identified associations between four single nucleotide polymorphisms and increased ALI susceptibility. Further studies are needed to examine the role of FAS in ALI.
#38 Acute Respiratory Distress Syndrome – Causes and Risk Factors | NHLBI, NIH
https://www.nhlbi.nih.gov/health/ards/causes
Damage to the lungs air sacs (called alveoli) causes ARDS. Fluid from tiny blood vessels leaks through the damaged walls of the air sacs and collects, limiting the lungs normal exchange of oxygen and carbon dioxide. […] The air sacs may become damaged as a result of an illness, such as a lung infection, or breathing in smoke. Other illnesses or injuries may trigger inflammation that damages the air sacs. […] Infections are the most common risk factors for ARDS. The most common are flu or other virus, such as respiratory syncytial virus and SARS-CoV-2, the virus responsible for COVID-19. […] Being exposed to air pollution for weeks or months can make you more vulnerable to ARDS. […] Habits that harm the health of your lungs increase your risk of ARDS. These include heavy alcohol use, overdose of illegal drugs, and smoking.
#39 Acute Respiratory Distress Syndrome — Aqualung Therapeutics, Corp
https://www.aqualungtherapeutics.com/acute-respiratory-distress-syndrome
It is not known by the researchers regarding who will develop ARDS. […] Transfusion of blood: products such as packed red blood cells, fresh frozen plasma, and platelets are risk factors of developing ARDS. […] Sepsis: Patients with widespread infection such as Sepsis are at high risk of developing ARDS. […] Physiological factors: Several Physiological risk factors such as blood acidemia, hypoalbuminia, low respiratory compliance, and high lactate also increases the chances of developing ARDS. […] Alcohol: Consumption of alcohol increases the risk of developing ARDS. It is found that patients with history of chronic alcoholism are at higher risk of developing ARDS.
#40 Learn About ARDS | American Lung Association
https://www.lung.org/lung-health-diseases/lung-disease-lookup/ards/learn-about-ards
Acute respiratory distress syndrome (ARDS) occurs when our lungs are severely injured, often by infection or trauma. […] ARDS causes fluid to leak into the lungs, making it difficult to get oxygen into the bloodstream. […] ARDS results from lung injury. The exact nature of the injury is not always clear. Common injuries are: […] Sepsis, a life-threatening condition occurs when your immune system must work aggressively to fight off infection or trauma […] Inhaling harmful substances […] Pneumonia […] Trauma to the head, chest or other areas of the body […] Blood transfusions […] Pancreatitis […] Near drowning. […] While it is not clear who will develop ARDS, certain factors may increase the risk for ARDS including: […] Advanced age […] A history of tobacco use […] A history of alcoholism […] Presence of chronic lung disease […] High-risk surgery.
#41 Learn About ARDS | American Lung Association
https://www.lung.org/lung-health-diseases/lung-disease-lookup/ards/learn-about-ards
Acute respiratory distress syndrome (ARDS) occurs when our lungs are severely injured, often by infection or trauma. […] ARDS causes fluid to leak into the lungs, making it difficult to get oxygen into the bloodstream. […] ARDS results from lung injury. The exact nature of the injury is not always clear. Common injuries are: […] Sepsis, a life-threatening condition occurs when your immune system must work aggressively to fight off infection or trauma […] Inhaling harmful substances […] Pneumonia […] Trauma to the head, chest or other areas of the body […] Blood transfusions […] Pancreatitis […] Near drowning. […] While it is not clear who will develop ARDS, certain factors may increase the risk for ARDS including: […] Advanced age […] A history of tobacco use […] A history of alcoholism […] Presence of chronic lung disease […] High-risk surgery.
#42 Acute Respiratory Distress Syndrome – Causes and Risk Factors | NHLBI, NIH
https://www.nhlbi.nih.gov/health/ards/causes
Damage to the lungs air sacs (called alveoli) causes ARDS. Fluid from tiny blood vessels leaks through the damaged walls of the air sacs and collects, limiting the lungs normal exchange of oxygen and carbon dioxide. […] The air sacs may become damaged as a result of an illness, such as a lung infection, or breathing in smoke. Other illnesses or injuries may trigger inflammation that damages the air sacs. […] Infections are the most common risk factors for ARDS. The most common are flu or other virus, such as respiratory syncytial virus and SARS-CoV-2, the virus responsible for COVID-19. […] Being exposed to air pollution for weeks or months can make you more vulnerable to ARDS. […] Habits that harm the health of your lungs increase your risk of ARDS. These include heavy alcohol use, overdose of illegal drugs, and smoking.
#43 Acute Respiratory Distress Syndrome (ARDS): Practice Essentials, Background, Pathophysiology
https://emedicine.medscape.com/article/165139-overview
General risk factors for ARDS have not been prospectively studied using the 1994 EACC criteria. However, several factors appear to increase the risk of ARDS after an inciting event, including advanced age, female sex (noted only in trauma cases), cigarette smoking, and alcohol use. For any underlying cause, increasingly severe illness as predicted by a severity scoring system such as the Acute Physiology And Chronic Health Evaluation (APACHE) increases the risk of development of ARDS. […] A study by Glavan et al examined the association between genetic variations in the FAS gene and ALI susceptibility. The study identified associations between four single nucleotide polymorphisms and increased ALI susceptibility. Further studies are needed to examine the role of FAS in ALI.
#44 Acute Respiratory Distress Syndrome (ARDS): Practice Essentials, Background, Pathophysiology
https://emedicine.medscape.com/article/165139-overview
General risk factors for ARDS have not been prospectively studied using the 1994 EACC criteria. However, several factors appear to increase the risk of ARDS after an inciting event, including advanced age, female sex (noted only in trauma cases), cigarette smoking, and alcohol use. For any underlying cause, increasingly severe illness as predicted by a severity scoring system such as the Acute Physiology And Chronic Health Evaluation (APACHE) increases the risk of development of ARDS. […] A study by Glavan et al examined the association between genetic variations in the FAS gene and ALI susceptibility. The study identified associations between four single nucleotide polymorphisms and increased ALI susceptibility. Further studies are needed to examine the role of FAS in ALI.
#45 Acute Respiratory Distress Syndrome — Aqualung Therapeutics, Corp
https://www.aqualungtherapeutics.com/acute-respiratory-distress-syndrome
It is not known by the researchers regarding who will develop ARDS. […] Transfusion of blood: products such as packed red blood cells, fresh frozen plasma, and platelets are risk factors of developing ARDS. […] Sepsis: Patients with widespread infection such as Sepsis are at high risk of developing ARDS. […] Physiological factors: Several Physiological risk factors such as blood acidemia, hypoalbuminia, low respiratory compliance, and high lactate also increases the chances of developing ARDS. […] Alcohol: Consumption of alcohol increases the risk of developing ARDS. It is found that patients with history of chronic alcoholism are at higher risk of developing ARDS.
#46 Acute Respiratory Distress Syndrome (ARDS): Practice Essentials, Background, Pathophysiology
https://emedicine.medscape.com/article/165139-overview
General risk factors for ARDS have not been prospectively studied using the 1994 EACC criteria. However, several factors appear to increase the risk of ARDS after an inciting event, including advanced age, female sex (noted only in trauma cases), cigarette smoking, and alcohol use. For any underlying cause, increasingly severe illness as predicted by a severity scoring system such as the Acute Physiology And Chronic Health Evaluation (APACHE) increases the risk of development of ARDS. […] A study by Glavan et al examined the association between genetic variations in the FAS gene and ALI susceptibility. The study identified associations between four single nucleotide polymorphisms and increased ALI susceptibility. Further studies are needed to examine the role of FAS in ALI.
#47 Acute Respiratory Distress Syndrome (ARDS): Symptoms & Treatment
https://resources.healthgrades.com/right-care/lungs-breathing-and-respiration/acute-respiratory-distress-syndrome-ards
Acute respiratory distress syndrome is the result of severe inflammation. The inflammation causes tiny blood vessels in the lungs to become âleaky.â Fluid finds its way out of these blood vessels and into the alveoliâor air sacs. As the air sacs fill with fluid, breathing becomes difficult. The lungs are not able to provide enough oxygen for the rest of the body to function normally. […] There are direct and indirect underlying causes of the inflammation at the root of ARDS. Direct causes, which have a primary effect on the lungs, include: […] Indirect causes, which have a secondary effect on the respiratory system, include:
#48 Acute Respiratory Distress Syndrome – Pulmonary Pathophysiology for Pre-Clinical Students
https://pressbooks.lib.vt.edu/pulmonarypathophysiology/chapter/acute-respiratory-distress-syndrome/
Regardless of the insults route or indeed form, the ensuing pathological events are similar and lead to the same alteration of the lungs. What is initiated is a defensive inflammatory response, and what results is vascular endothelial and alveolar epithelial damage and a leaky alveolar capillary membrane. […] The injury causes release of inflammatory cytokines, and tumor necrosis factor, interleukin (IL)-1, IL-6, and IL-8 have been shown to be particularly involved in ARDS. […] The neutrophils, however, begin to release toxic mediators, but rather than resolve the underlying, initial problem, the released reactive oxygen species and proteases disrupt the capillary endothelium and the alveolar epithelium. […] The lack of gas exchange from affected areas produces a right-left shunt and hypoxemia will result.
#49 Acute Respiratory Distress Syndrome – Pulmonary Pathophysiology for Pre-Clinical Students
https://pressbooks.lib.vt.edu/pulmonarypathophysiology/chapter/acute-respiratory-distress-syndrome/
Regardless of the insults route or indeed form, the ensuing pathological events are similar and lead to the same alteration of the lungs. What is initiated is a defensive inflammatory response, and what results is vascular endothelial and alveolar epithelial damage and a leaky alveolar capillary membrane. […] The injury causes release of inflammatory cytokines, and tumor necrosis factor, interleukin (IL)-1, IL-6, and IL-8 have been shown to be particularly involved in ARDS. […] The neutrophils, however, begin to release toxic mediators, but rather than resolve the underlying, initial problem, the released reactive oxygen species and proteases disrupt the capillary endothelium and the alveolar epithelium. […] The lack of gas exchange from affected areas produces a right-left shunt and hypoxemia will result.
#50 Understanding Acute Respiratory Distress Syndrome (ARDS)Â
http://library.oumedicine.com/Search/3,90903
Acute respiratory distress syndrome (ARDS) is a severe lung condition. ARDS causes lungs to become inflamed and the small air sacs in the lungs (alveoli) to fill with fluid. […] Experts dont yet understand why ARDS occurs in some people and not in others. It can happen after an illness or injury, such as: […] Certain things can make you more at risk for ARDS. These include: […] ARDS can cause scarring of the lungs (fibrosis). It can cause organ failure from lack of oxygen to the organs. It can also cause death. […] You can lower your risk for ARDS by:
#51 Understanding Acute Respiratory Distress Syndrome (ARDS)Â
http://library.oumedicine.com/Search/3,90903
Acute respiratory distress syndrome (ARDS) is a severe lung condition. ARDS causes lungs to become inflamed and the small air sacs in the lungs (alveoli) to fill with fluid. […] Experts dont yet understand why ARDS occurs in some people and not in others. It can happen after an illness or injury, such as: […] Certain things can make you more at risk for ARDS. These include: […] ARDS can cause scarring of the lungs (fibrosis). It can cause organ failure from lack of oxygen to the organs. It can also cause death. […] You can lower your risk for ARDS by:
#52 Acute Respiratory Distress Syndrome: Diagnosis and Management | AAFP
https://www.aafp.org/pubs/afp/issues/2012/0215/p352.html
Acute respiratory distress syndrome is believed to occur when a pulmonary or extrapulmonary insult causes the release of inflammatory mediators, promoting neutrophil accumulation in the microcirculation of the lung. […] Most cases of acute respiratory distress syndrome are associated with pneumonia or sepsis. […] Most cases of ARDS in adults are associated with pulmonary sepsis (46 percent) or nonpulmonary sepsis (33 percent). […] Risk factors include those causing direct lung injury (e.g., pneumonia, inhalation injury, pulmonary contusion) and those causing indirect lung injury (e.g., nonpulmonary sepsis, burns, transfusion-related acute lung injury). […] Recent studies indicate that the incidence of adult acute lung injury and ARDS is 22 to 86 cases per 100,000 person-years and up to 64 cases per 100,000 person-years, respectively. […] Risk factors for mortality include increasing age, worsening multiorgan dysfunction, presence of pulmonary and nonpulmonary comorbidities, higher Acute Physiology and Chronic Health Evaluation (APACHE) II score, and acidosis. […] Most ARDS-related deaths are due to multiorgan failure.
#53 Causes and attributable fraction of death from ARDS in inflammatory phenotypes of sepsis | Critical Care | Full Text
https://ccforum.biomedcentral.com/articles/10.1186/s13054-024-04943-x
Hypoinflammatory and hyperinflammatory phenotypes have been identified in both Acute Respiratory Distress Syndrome (ARDS) and sepsis. Attributable mortality of ARDS in each phenotype of sepsis is yet to be determined. […] The PAFARDS was 19% (95%CI 10,28%) in hypoinflammatory sepsis and, 14% (95%CI 6,20%) in hyperinflammatory sepsis. Cause of death differed between the two phenotypes (p0.001). Respiratory failure was the most common cause of death in hypoinflammatory sepsis, whereas circulatory shock was the most common cause in hyperinflammatory sepsis. […] The attributable fraction of death from sepsis-associated ARDS (AFARDS) is the proportion of deaths attributable to ARDS among all deaths in patients who developed sepsis-associated ARDS. The population AFARDS (PAFARDS) in this context is the proportion of deaths that would be prevented following elimination of ARDS in patients with sepsis.
#54 Acute Respiratory Distress Syndrome: Diagnosis and Management | AAFP
https://www.aafp.org/pubs/afp/issues/2012/0215/p352.html
Acute respiratory distress syndrome is believed to occur when a pulmonary or extrapulmonary insult causes the release of inflammatory mediators, promoting neutrophil accumulation in the microcirculation of the lung. […] Most cases of acute respiratory distress syndrome are associated with pneumonia or sepsis. […] Most cases of ARDS in adults are associated with pulmonary sepsis (46 percent) or nonpulmonary sepsis (33 percent). […] Risk factors include those causing direct lung injury (e.g., pneumonia, inhalation injury, pulmonary contusion) and those causing indirect lung injury (e.g., nonpulmonary sepsis, burns, transfusion-related acute lung injury). […] Recent studies indicate that the incidence of adult acute lung injury and ARDS is 22 to 86 cases per 100,000 person-years and up to 64 cases per 100,000 person-years, respectively. […] Risk factors for mortality include increasing age, worsening multiorgan dysfunction, presence of pulmonary and nonpulmonary comorbidities, higher Acute Physiology and Chronic Health Evaluation (APACHE) II score, and acidosis. […] Most ARDS-related deaths are due to multiorgan failure.
#55 High-fidelity discrimination of ARDS versus other causes of respiratory failure using natural language processing and iterative machine learning | medRxiv
https://www.medrxiv.org/content/10.1101/2021.01.26.21250316v1.full-text
Despite the high morbidity and mortality associated with Acute Respiratory Distress Syndrome (ARDS), discrimination of ARDS from other causes of acute respiratory failure remains challenging, particularly in the first 24 hours of mechanical ventilation. […] The pathophysiologic definition of ARDS has been refined since the diseases initial description in 2000, but consists of diffuse lung inflammatory changes with increased vascular permeability. […] As there are no known biomarkers that can diagnose ARDS, a real-time implementable patient classification framework that can help discriminate between ARDS versus non-ARDS causes of respiratory failure could assist with earlier identification and potentially reduce the associated morbidity and mortality. […] The model building process we employed independently optimized five model configurations, each leveraging different input feature sets.
#56
https://step2.medbullets.com/pulmonary/120671/acute-respiratory-distress-syndrome-ards
Etiology […] Pneumonia (most common risk factor) […] Aspiration […] Pulmonary contusion […] Acute pancreatitis […] Sepsis […] Pathogenesis […] injury and inflammation to the alveoli increases pulmonary capillary permeability […] phases […] exudative […] immune-mediated destruction of the epithelial-interstitial-endothelial barrier […] allows fluid into the interstitium and airspace […] proliferative […] recovery of the destroyed barrier […] fibrotic […] impaired removal of alveolar collagen that was produced during the early injury process limits functional recovery […] impaired gas exchange […] […] […] Severe ARDS has the worst mortality (45%) compared to mild and moderate
#57 Acute respiratory distress syndrome: Clinical features, diagnosis, and complications in adults – UpToDate
https://www.uptodate.com/contents/acute-respiratory-distress-syndrome-clinical-features-diagnosis-and-complications-in-adults
Acute respiratory distress syndrome (ARDS) is an acute, diffuse, inflammatory form of lung injury that is associated with a variety of etiologies. Recognizing and promptly treating ARDS is critical to reduce the associated high mortality. […] Etiology of acute respiratory distress syndrome* […] Causes of diffuse alveolar damage.
#58 High-fidelity discrimination of ARDS versus other causes of respiratory failure using natural language processing and iterative machine learning | medRxiv
https://www.medrxiv.org/content/10.1101/2021.01.26.21250316v1.full-text
Despite the high morbidity and mortality associated with Acute Respiratory Distress Syndrome (ARDS), discrimination of ARDS from other causes of acute respiratory failure remains challenging, particularly in the first 24 hours of mechanical ventilation. […] The pathophysiologic definition of ARDS has been refined since the diseases initial description in 2000, but consists of diffuse lung inflammatory changes with increased vascular permeability. […] As there are no known biomarkers that can diagnose ARDS, a real-time implementable patient classification framework that can help discriminate between ARDS versus non-ARDS causes of respiratory failure could assist with earlier identification and potentially reduce the associated morbidity and mortality. […] The model building process we employed independently optimized five model configurations, each leveraging different input feature sets.
#59 ARDS | Sepsis Alliance
https://www.sepsis.org/sepsisand/ards/
Although several causes can result in ARDS, including trauma or aspiration, the most common cause is sepsis. […] If the cause was sepsis, this treatment would include antibiotics if the cause is a bacterial infection, intravenous (IV) fluids, and possibly medications called vasopressors to help raise your blood pressure.
#60 Towards a biological definition of ARDS: are treatable traits the solution? | Intensive Care Medicine Experimental | Full Text
https://icm-experimental.springeropen.com/articles/10.1186/s40635-022-00435-w
Biological data may, however, advance our understanding and treatment of ARDS without the need to reformulate the consensus criteria for ARDS. […] The corresponding inclusion criteria of an interventional trial would combine the Berlin definition and the biological abnormality of interest (such as increased alveolar capillary barrier permeability). […] Biological materials should ideally be collected as part of all RCTs in ARDS patients to allow for testing of heterogeneity of treatment effect in biological subphenotypes.
#61 JCM | Special Issue : Acute Respiratory Distress Syndrome (ARDS): Causes, Management, and Treatment
https://www.mdpi.com/journal/jcm/special_issues/L5DVUEL250
Acute respiratory distress syndrome (ARDS) is an acute life-threatening condition resulting from pulmonary causes (e.g., infective, aspiration pneumonia) or extra-pulmonary causes, (e.g., sepsis, trauma, massive transfusion, pancreatitis). […] Despite the advance in the knowledge of its pathophysiologic mechanisms, ARDS treatment mainly consists of supportive caresâfrom lung-protective ventilatory strategies and pronation up to extracorporeal membrane oxygenation (ECMO) supportâand the management of the underlying causes.
#62 Acute Respiratory Distress Syndrome (Shock Lung) in Cats | VCA Animal Hospitals
https://vcahospitals.com/know-your-pet/acute-respiratory-distress-syndrome-shock-lung-in-cats
ARDS is a complication of other severe systemic diseases. These diseases may include sepsis (infection), pancreatitis, pneumonia (due to infection or the inhalation of foreign materials), and other severe illnesses. Some cases are caused by severe trauma, near-drowning, snake bite, and other accidents. […] In each of these conditions, massive body-wide inflammation frequently occurs. ARDS is one known complication of this massive inflammation. In most cases, ARDS occurs one to four days after the onset of the pets severe inflammatory disease. […] There is no specific medication that has proven beneficial in the treatment of ARDS. A number of drugs are used in these cases, including medications that influence lung function and inflammation as well as antibiotics.