ARDS

Acute respiratory distress syndrome (ARDS) is a life threatening respiratory condition in which
the lungs suffer severe widespread injury, interfering with their ability to take up oxygen. A low
blood oxygen level and the inability to get oxygen to normal levels is the hallmark of ARDS.
ARDS was defined as: the acute onset of respiratory failure, bilateral infiltrates on chest
radiograph, hypoxemia as defined by a PaO2/FiO2 ratio 200 mmHg, and no evidence of left atrial
hypertension or a pulmonary capillary pressure <18 mmHg (if measured) to rule out cardiogenic
edema. In addition, Acute Lung Injury (ALI), the less severe form of acute respiratory failure, was
different from ARDS only for the degree of hypoxemia, in fact it was defined by a 200 <
PaO2/FiO2 300 mmHg. ARDS has been widely recognized as a major clinical problem
worldwide, carrying a high morbidity and mortality burden. Without mechanical ventilation, most
patients would not survive. The incidence of ARDS ranges from 1.5 cases per 100.000 to nearly
79 cases per 100.000, with European countries reporting a lower incidence than USA, while studies
from Brazil reported incidence rates ranging from 1.8 to 31 per 100.000. Although most ARDS
predisposing conditions are well known, there is insufficient awareness about environmental and
individual risk factors. Chronic alcohol abuse and active or passive cigarette smoke have been
associated with an increased incidence of ARDS.

In addition to lack of sensitive and specific diagnostic criteria for ARDS, there are very few
effective therapies for ARDS other than the use of lung protection strategies. This lack of
therapeutic modalities is certainly related to the complex, pathogenesis of this syndrome with
multiple signaling pathways activated depending on the type of lung injury. Treatment of ARDS
includes management of hypoxemia and other supportive care. In particular, invasive mechanical
ventilation with lung protective strategies is the mainstay of ARDS treatment, although long-term
intubation may carry a high rate of complications, such as ventilator-associated pneumonia (VAP),
delirium and critical illness myopathy and neuropathy.