Acute Respiratory Distress Syndrome

Year 2015, Volume: 7 Issue: 1, 1 - 5, 01.04.2015

Onur Selvi Özgür Şentürk

Abstract

Acute Respiratory Distress Syndrome ARDS is a life threatening disease with high mortality and morbidity and there has been many studies on its pathogenesis and pathophysiology since it was first described in 1967. ARDS had its current definition as a result of American-European Consensus Meeting in 1994 AECC-1994 . According to this latest definition acute lung injury ALI is described with PaO2/FiO2 ratio less than 300 mmHg, acute onset, bilateral radiographic opacities without evidence of left atrial hypertension and pulmonary occlusion pressure less than 18mmHg PCWP ≤ 18mm Hg . PaO2/FiO2 ratio less than 200 mmHg is named as ARDS. There are still numerous ongoing studies about its physiopathology, epidemiology, mortality, morbidity and controversial results of these studies require elaborative reading. The aim of this review is to summarize suggested ARDS models and mechanisms of its pathophysiology. Lung protective ventilatio techniques, extracorporeal membrane oxygenation, current medical treatments, genetic and stem cell studies and potential new treatments rising from recent studies are presented with knowledge from recent literatures.

Keywords

ARDS, ALI

Akut Respiratuvar Distress Sendromu

Abstract

Akut Respiratuvar Distress Sendromu ARDS ilk kez 1967 yılında tanımlandığı günden bu güne tanımı, patogenezi ve patofizyolojisi üzerine çok sayıda araştıma yapılmış, hayatı tehtid eden ciddi mortalite ve morbiditesi bulunan bir durumdur. 1994 yılında yapılan Avrupa ve Amerika Uzlaşı konferansı sonucunda AECC- 1994 ARDS‟nin günümüzdeki tanımı yapılmıştır. Bu en son tanıma göre akut akciğer hasarı ALI akut başlayan, akciğer grafisinde bilateral infiltrasyona sebep olan, pulmoner arter oklüzyon basıncının 18mmHg‟den küçük olduğu PCWP ≤ 18mm Hg ve sol atriyum hipertansiyonu ile ilişkili olmayan, PaO2/FiO2 oranı ≤ 300 olduğu durumları kapsarken, ARDS PaO2/ FiO2 oranı ≤ 200 olan durumları içermektedir. ARDS‟nin tanımı, oluşum patofizyolojisi, epidemiyolojisi, mortalitesi ve morbiditesi üzerine bir çok araştırma devam ederken günümüze kadar elde edilen bulgular birbiri ile çelişen ve tartışmaya açık sonuçları ile dikkatli bir okuma yapılmasını gerekli kılmaktadır. Bu amaçla ele alınan bu derlemede ARDS ve patofizyolojisi ile ilgili önerilmiş modellemeler ve mekanizmalar özetlenmiştir. Akciğer koruyucu ventilasyon teknikleri, ekstra korporeal membran oksijenizasyonu, güncel medikal tedaviler, gen ve kök hücre tedavileri ve güncel literatür bilgisinin ışığında mevcut araştırmalarla ortaya çıkan yeni potansiyel tedavi yöntemleri vurgulanmıştır.

Keywords

ARDS, ALI

References

• Asbaugh DG, Bigelow DB, Petty TL, Levine BE. Acute respiratory distress in adults. Lancet 1967;2:319.
• Matthay MA1, Ware LB, Zimmerman GA. The acute respiratory distress syndrome. J Clin Invest 2012 ;122(8):2731-2740.
• Cortés I1, Peñuelas O, Esteban A. Acute respiratory distress syndrome: evaluation and management. Minerva Anestesiol 2012;78(3):343-57
• Thille AW1, Esteban A, Fernández-Segoviano P, et al. Comparison of the Berlin definition for acute respiratory distress syndrome with autopsy. Am J Respir Crit Care Med 2013; 1;187(7):761-767.
• Acute Respiratory Distress Syndrome The Berlin Definition. The ARDS Definition Task Force. JAMA 2012;307(23):2526-253.
• Michael A. Matthay, Rachel L. Zemans The Acute Respiratory Distress Syndrome: Patho- genesis and Treatment Annu Rev Pathol. 2011; 28: 6: 147–163.
• Erickson S E, Martin G S, Davis J L, Matthay M A, Eisner M D. Recent Trends in Acute Lung In- jury Mortality1996-2005. Crit Care Med 2009; 37(5): 1574–1579.
• Fan E, Villar J, Slutsky A S. Novel approaches to minimize ventilator-induced lung injury BMC Med 2013; 11: 85.
• Frank JA, Gutierrez JA, Jones KD, Allen L, Dobbs L, Matthay MA Low tidal volume reduces epithelial and endothelial injury in acid-injured rat lungs. Am J Respir Crit Care Med 2002 15;165(2):242-49
• Y, Parodo J, Kajikawa O, et al.Injurious me- chanical ventilation and end-organ epithelial cell apoptosis and organ dysfunction in an ex- perimental model of acute respiratory distress syndrome. JAMA. 2003 ;23:30;289(16):2104- 2112.
• Briel M, Meade M, Mercat A, et al Higher vs lower positive end-expiratory pressure in pa- tients with acute lung injury and acute respira- tory distress syndrome: systematic review and meta-analysis. JAMA 2010 ;3:303(9):865-873.
• The Acute Respiratory Distress Syndrome Network .Ventilation with Lower Tidal Volumes as Compared with Traditional Tidal Volumes for Acute Lung Injury and the Acute Respira- tory Distress Syndrome N Engl J Med 2000; 342:1301-1308.
• NIH NHLBI ARDS Clinical Network Mechanical Ventilation Protocol, Ferguson ND1, Cook DJ, Guyatt GH, et al. High-frequency oscillation in early acute respiratory distress syndrome. N Engl J Med 2013; 28:368(9):795-805
• Fan E, Villar J, Slutsky AS. Novel approaches to minimize ventilator-induced lung injury. BMC Med.2013 ;28:11:85.Donahoe M. Acute respiratory distress syndrome: A clinical review. Pulm Circ 2011; 1(2): 192–211
• Papazian L, Forel JM, Gacouin A, Penot-Ragon C et al.Neuromuscular blockers in early acute respiratory distress syndrome. N Engl J Med 2010 ;16:363(12):1107-1108
• Clinical Trials Network, Wiedemann HP, Wheel- er AP, et al.Comparison of two fluid- manage- ment strategies in acute lung injury.N Engl J Med 2006 ;15:354(24):2564-75
• Calfee CS1, Gallagher D, Abbott J, Thompson BT, Matthay MA; NHLBI ARDS Network.
• Plasma angiopoietin-2 in clinical acute lung injury: prognostic and pathogenetic signifi- cance. Crit Care Med. 2012;40(6):1731-1737.
• Boyle AJ, Mac Sweeney R, McAuley DF. Phar- macological treatments in ARDS; a state-of- the-art update. BMC Med. 2013 ;20;11:166
• Devaney J, Contreras M, Laffey JG. Clinical review: gene-based therapies for ALI/ARDS: where are we now? Crit Care 2011;15(3):224.
• Lin X1, Dean DA. Gene therapy for ALI/ARDS. Crit Care Clin. 2011;27(3):705-718.
• Islam MN, Das SR, Emin MT, et al. Mitochon- drial transfer from bone-marrow-derived stromal cells to pulmonary alveoli protects against acute lung injury. Nat Med. 2012 ;15:18(5):759-765.
• Hayes M, Curley G, Ansari B, Laffey JG. Clinical review: Stem cell therapies for acute lung inju- ry/acute respiratory distress syndrome - hope or hype? Crit Care 2012 12;16(2):205.