ARDS Clinical Challenges

Overview

 

Acute Respiratory Distress Syndrome (ARDS) is a complex, rapid, and distinct acute respiratory failure characterized by hypoxemia, widespread inflammation in both lungs, and pulmonary edema [1][2][3]. Approximately 10.4% of patients admitted to the Intensive Care Unit (ICU) resulted in ARDS [6], and around 60-70% of COVID-19 patients admitted in ICU resulted in ARDS [8]. Although outcomes in recent years have improved, mortality rates remain high [1].

ARDS remains a problem globally

 

2M

Patients affected by ARDS globally in 2017 [4]

40%

Mortality rate for ARDS [1]

60-70%

COVID-19 patients admitted to the ICU resulted in ARDS [8]

 

Current limitations in ARDS management

 

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Ventilation Mode

Low tidal volume ventilation is currently the only treatment shown to reduce mortality rates [1][2][3][5].

 

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Ventilator Settings

Incorrect ventilator settings may induce more lung damage, worsening outcomes.

 

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No Consensus

Research has shown that there is currently no consensus among clinicians on how to set ventilator settings for ARDS patients [7].

 

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Invasive

Currently, there is no non-invasive monitoring technique to assess shunt fraction.

1. Lumb, A.B., Nunn's applied respiratory physiology eBook. 2016: Elsevier Health Sciences.

2. Coudroy, R., F. Boissier, and A.W. Thille, Acute Respiratory Distress Syndrome (ARDS): Definition, Incidence, and Outcome, in Acute Respiratory Distress Syndrome. 2017, Springer. p. 1-13.

3. Gattinoni, L., et al., Positive end-expiratory pressure: how to set it at the individual level. Annals of Translational Medicine, 2017. 5(14): p. 288.

4. Bellani G, Laffey JG, Pham T, et al. Epidemiology, Patterns of Care, and Mortality for Patients With Acute Respiratory Distress Syndrome in Intensive Care Units in 50 Countries. JAMA. 2016;315(8):788–800.

5. Brower, R., et al., The Acute Respiratory Distress Syndrome Network. Ventilation with lower tidal volumes as compared with traditional tidal volumes for acute lung injury and the acute respiratory distress syndrome. N Engl J Med, 2000. 342(18): p. 1301-8.

6. Pham T, Rubenfeld GD. Fifty Years of Research in ARDS. The Epidemiology of Acute Respiratory Distress Syndrome. A 50th Birthday Review. Am J Respir Crit Care Med. 2017 Apr;195(7):860-870

7. Diamond M, Peniston Feliciano HL, Sanghavi D, et al. Acute Respiratory Distress Syndrome. [Updated 2021 Jan 29]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2021 Jan-. Available from: https://www.ncbi.nlm.nih.gov/nooks/NBK436002/

8. Phua, J., Weng, L., Ling, L., Egi, M., Lim, C. M., Divatia, J. V., ... & Asian Critical Care Clinical Trials Group. (2020). Intensive care management of coronavirus disease 2019 (COVID-19): challenges and recommendations. The Lancet Respiratory Medicine, 8(5), 506-517