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SUMMARY:
The acute respiratory distress syndrome (ARDS) is a common cause of respiratory failure in
critically ill patients and is defined by the acute onset of noncardiogenic pulmonary edema,
hypoxemia and the need for mechanical ventilation. ARDS occurs most often in the setting of
pneumonia, sepsis, aspiration of gastric contents or severe trauma and is present in ~10% of all
patients in intensive care units worldwide. Despite some improvements, mortality remains high
at 30–40% in most studies. Pathological specimens from patients with ARDS frequently reveal
diffuse alveolar damage, and laboratory studies have demonstrated both alveolar epithelial and
lung endothelial injury, resulting in accumulation of protein-rich inflammatory edematous fluid
in the alveolar space. Diagnosis is based on consensus syndromic criteria, with modifications for
under-resourced settings and in pediatric patients. Treatment focuses on lung-protective
ventilation; no specific pharmacotherapies have been identified. Long-term outcomes of patients
with ARDS are increasingly recognized as important research targets, as many patients survive
ARDS only to have ongoing functional and/or psychological sequelae. Future directions include
efforts to facilitate earlier recognition of ARDS, identifying responsive subsets of patients and
ongoing efforts to understand fundamental mechanisms of lung injury to design specific
treatments.
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