Acute Respiratory Distress Syndrome

  • Zachary D. Levy
  • Todd L. Slesinger
  • Brian J. Wright


In 1967, Ashbaugh, et al. published a case series of 12 patients in The Lancet where they described a respiratory malady characterized by tachypnea, hypoxemia, and a loss of lung compliance, brought on by a variety of different stimuli. They noted that the condition bore a resemblance to “congestive atelectasis” and that the most effective therapy was positive end-expiratory pressure (PEEP) (Ashbaugh DG, Bigelow DB, Petty TL, Levine BE, Lancet 2:319–23, 1967). Today, we readily identify the condition as acute respiratory distress syndrome (ARDS), at times known as “adult respiratory distress syndrome,” “shock lung,” “wet lung,” or “Da-Nang lung” (owing to the large volume of cases treated at the port city during the Vietnam War). What was once a dim recognition of heterogeneously triggered clinical symptoms is now a comprehensive and continuously evolving understanding of a discrete syndrome. Here, we will briefly describe the epidemiology of ARDS, explore the pathophysiology of ARDS-related lung injury, identify precipitating factors, and discuss current and future treatment approaches.


Respiratory Distress ARDS Critical care Tidal volumes Distress syndrome 


  1. 1.
    Ashbaugh DG, Bigelow DB, Petty TL, Levine BE. Acute respiratory distress in adults. Lancet. 1967;2(7511):319–23.PubMedGoogle Scholar
  2. 2.
    Ranieri VM, Rubenfeld GD, Thompson BT, et al. Acute respiratory distress syndrome: the Berlin definition. JAMA. 2012;307(23):2526–33.PubMedGoogle Scholar
  3. 3.
    Bernard GR, Artigas A, Brigham KL, et al. The American-European consensus conference on ARDS. Definitions, mechanisms, relevant outcomes, and clinical trial coordination. Am J Respir Crit Care Med. 1994;149(3 Pt 1):818–24.PubMedGoogle Scholar
  4. 4.
    Frohlich S, Doolan A, Murphy N, Crotty T, Boylan J. Comparison of the accuracy of the AECC and Berlin definitions in diagnosing ARDS. Am J Respir Crit Care Med. 2013;187:A2211.Google Scholar
  5. 5.
    Villar, et al. Intensive Care Med. 2011;37(12):1932–41.PubMedGoogle Scholar
  6. 6.
    Rubenfield, et al. N Engl J Med. 2005;353(16):1685–93.Google Scholar
  7. 7.
    Zambon M, Vincent JL. Mortality rates for patients with acute lung injury/ARDS have decreased over time. Chest. 2008;133(5):1120–7.PubMedGoogle Scholar
  8. 8.
    Gajic O, Dabbagh O, Park PK, et al. Early identification of patients at risk of acute lung injury: evaluation of lung injury prediction score in a multicenter cohort study. Am J Respir Crit Care Med. 2011;183(4):462–70.PubMedGoogle Scholar
  9. 9.
    Tomashefski JF. Pulmonary pathology of the adult respiratory distress syndrome. Clin Chest Med. 1990;11(4):593–619.PubMedGoogle Scholar
  10. 10.
    Walkey AJ, Summer R, Ho V, Alkana P. Acute respiratory distress syndrome: epidemiology and management approaches. Clin Epidemiol. 2012;4:159–69.PubMedPubMedCentralGoogle Scholar
  11. 11.
    Bellingan GJ. The pulmonary physician in critical care ∗ 6: the pathogenesis of ALI/ARDS. Thorax. 2002;57(6):540–6.PubMedPubMedCentralGoogle Scholar
  12. 12.
    Mendez JL, Hubmayr RD. New insights into the pathology of acute respiratory failure. Curr Opin Crit Care. 2005;11(1):29–36.PubMedGoogle Scholar
  13. 13.
    Martin C, Papazian L, Payan MJ, Saux P, Gouin F. Pulmonary fibrosis correlates with outcome in adult respiratory distress syndrome. A study in mechanically ventilated patients. Chest. 1995;107(1):196–200.PubMedGoogle Scholar
  14. 14.
    Slutsky AS, Ranieri VM. Ventilator-induced lung injury. N Engl J Med. 2013;369(22):2126–36.PubMedPubMedCentralGoogle Scholar
  15. 15.
    Bhargava M, Wendt CH. Biomarkers in acute lung injury. Transl Res. 2012;159(4):205–17.PubMedPubMedCentralGoogle Scholar
  16. 16.
    Kumar A, Roberts D, Wood KE, et al. Duration of hypotension before initiation of effective antimicrobial therapy is the critical determinant of survival in human septic shock. Crit Care Med. 2006;34(6):1589–96.PubMedGoogle Scholar
  17. 17.
  18. 18.
    Ventilation with lower tidal volumes as compared with traditional tidal volumes for acute lung injury and the acute respiratory distress syndrome. The acute respiratory distress syndrome network. N Engl J Med. 2000;342(18):1301–8.Google Scholar
  19. 19.
    Serpa Neto A, Cardoso SO, Manetta JA, et al. Association between use of lung-protective ventilation with lower tidal volumes and clinical outcomes among patients without acute respiratory distress syndrome: a meta-analysis. JAMA. 2012;308(16):1651–9.PubMedGoogle Scholar
  20. 20.
    Guerin C, Debord S, Leray V, et al. Efficacy and safety of recruitment maneuvers in acute respiratory distress syndrome. Ann Intensive Care. 2011;1(1):9.PubMedPubMedCentralGoogle Scholar
  21. 21.
    Daoud EG, Farag HL, Chatburn RL. Airway pressure release ventilation: what do we know? Respir Care. 2012;57(2):282–92.PubMedGoogle Scholar
  22. 22.
    Ferguson ND, Cook DJ, Guyatt GH, et al. High-frequency oscillation in early acute respiratory distress syndrome. N Engl J Med. 2013;368(9):795–805.PubMedGoogle Scholar
  23. 23.
    Wiedemann HP, Wheeler AP, Bernard GR, et al. Comparison of two fluid-management strategies in acute lung injury. N Engl J Med. 2006;354(24):2564–75.PubMedGoogle Scholar
  24. 24.
    Wheeler AP, Bernard GR, Thompson BT, et al. Pulmonary-artery versus central venous catheter to guide treatment of acute lung injury. N Engl J Med. 2006;354(21):2213–24.PubMedGoogle Scholar
  25. 25.
    Steinberg KP, Hudson LD, Goodman RB, et al. Efficacy and safety of corticosteroids for persistent acute respiratory distress syndrome. N Engl J Med. 2006;354(16):1671–84.PubMedGoogle Scholar
  26. 26.
    Luce JM, Montgomery AB, Marks JD, Turner J, Metz CA, Murray JF. Ineffectiveness of high-dose methylprednisolone in preventing parenchymal lung injury and improving mortality in patients with septic shock. Am Rev Respir Dis. 1988;138(1):62–8.PubMedGoogle Scholar
  27. 27.
    Bernard GR, Luce JM, Sprung CL, et al. High-dose corticosteroids in patients with the adult respiratory distress syndrome. N Engl J Med. 1987;317(25):1565–70.PubMedGoogle Scholar
  28. 28.
    Papazian L, Forel JM, Gacouin A, et al. Neuromuscular blockers in early acute respiratory distress syndrome. N Engl J Med. 2010;363(12):1107–16.Google Scholar
  29. 29.
    Shafeeq H, Lat I. Pharmacotherapy for acute respiratory distress syndrome. Pharmacotherapy. 2012;32(10):943–57.PubMedGoogle Scholar
  30. 30.
    Forel JM, Roch A, Marin V, et al. Neuromuscular blocking agents decrease inflammatory response in patients presenting with acute respiratory distress syndrome. Crit Care Med. 2006;34(11):2749–57.PubMedGoogle Scholar
  31. 31.
    Alhazzani W, Alshahrani M, Jaeschke R, et al. Neuromuscular blocking agents in acute respiratory distress syndrome: a systematic review and meta-analysis of randomized controlled trials. Crit Care. 2013;17(2):R43.PubMedPubMedCentralGoogle Scholar
  32. 32.
    De jonghe B, Lacherade JC, Sharshar T, Outin H. Intensive care unit-acquired weakness: risk factors and prevention. Crit Care Med. 2009;37(10 Suppl):S309–15.PubMedGoogle Scholar
  33. 33.
    Ketoconazole for early treatment of acute lung injury and acute respiratory distress syndrome: a randomized controlled trial. The ARDS network. JAMA. 2000;283(15):1995–2002.Google Scholar
  34. 34.
    Randomized, placebo-controlled trial of lisofylline for early treatment of acute lung injury and acute respiratory distress syndrome. Crit Care Med. 2002;30(1):1–6.Google Scholar
  35. 35.
    Boyle AJ, MacSweeney R, Mcauley DF. Pharmacological treatments in ARDS; a state-of-the-art update. BMC Med. 2013;11:166.PubMedPubMedCentralGoogle Scholar
  36. 36.
    Afshari A, Brok J, Møller AM, Wetterslev J. Inhaled nitric oxide for acute respiratory distress syndrome (ARDS) and acute lung injury in children and adults. Cochrane Database Syst Rev. 2010;(7):CD002787.Google Scholar
  37. 37.
    Mcclave SA, Martindale RG, Vanek VW, et al. Guidelines for the provision and assessment of nutrition support therapy in the adult critically ill patient: Society of Critical Care Medicine (SCCM) and American Society for Parenteral and Enteral Nutrition (A.S.P.E.N.). JPEN J Parenter Enteral Nutr. 2009;33(3):277–316.PubMedGoogle Scholar
  38. 38.
    Krzak A, Pleva M, Napolitano LM. Nutrition therapy for ALI and ARDS. Crit Care Clin. 2011;27(3):647–59.PubMedGoogle Scholar
  39. 39.
    Rice TW, Wheeler AP, Thompson BT, et al. Enteral omega-3 fatty acid, gamma-linolenic acid, and antioxidant supplementation in acute lung injury. JAMA. 2011;306(14):1574–81.PubMedPubMedCentralGoogle Scholar
  40. 40.
    Guérin C, Reignier J, Richard JC, et al. Prone positioning in severe acute respiratory distress syndrome. N Engl J Med. 2013;368(23):2159–68.PubMedGoogle Scholar
  41. 41.
    Lee JM, Bae W, Lee YJ, Cho YJ. The efficacy and safety of prone positional ventilation in acute respiratory distress syndrome: updated study-level meta-analysis of 11 randomized controlled trials. Crit Care Med. 2014;42(5):1252–62.PubMedGoogle Scholar
  42. 42.
    Bryan AC. Conference on the scientific basis of respiratory therapy. Pulmonary physiotherapy in the pediatric age group. Comments of a devil's advocate. Am Rev Respir Dis. 1974;110(6 Pt 2):143–4.PubMedGoogle Scholar
  43. 43.
    Wagaman MJ, Shutack JG, Moomjian AS, Schwartz JG, ShaVer TH, Fox WW. Improved oxygenation and lung compliance with prone positioning of neonates. J Pediatr. 1979;94:787–91.PubMedGoogle Scholar
  44. 44.
    Brodie D, Bacchetta M. Extracorporeal membrane oxygenation for ARDS in adults. N Engl J Med. 2011;365(20):1905–14.PubMedGoogle Scholar
  45. 45.
    Peek GJ, Mugford M, Tiruvoipati R, et al. Efficacy and economic assessment of conventional ventilatory support versus extracorporeal membrane oxygenation for severe adult respiratory failure (CESAR): a multicentre randomised controlled trial. Lancet. 2009;374(9698):1351–63.PubMedGoogle Scholar
  46. 46. ID: NCT01470703.
  47. 47.
    Fitzgerald M, Millar J, Blackwood B, et al. Extracorporeal carbon dioxide removal for patients with acute respiratory failure secondary to the acute respiratory distress syndrome: a systematic review. Crit Care. 2014;18(3):222.PubMedPubMedCentralGoogle Scholar
  48. 48.
    Herridge MS, Tansey CM, Matté A, et al. Functional disability 5 years after acute respiratory distress syndrome. N Engl J Med. 2011;364(14):1293–304.PubMedGoogle Scholar
  49. 49.
    Davidson TA, Caldwell ES, Curtis JR, Hudson LD, Steinberg KP. Reduced quality of life in survivors of acute respiratory distress syndrome compared with critically ill control patients. JAMA. 1999;281(4):354–60.PubMedGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2020

Authors and Affiliations

  • Zachary D. Levy
    • 1
  • Todd L. Slesinger
    • 2
  • Brian J. Wright
    • 3
  1. 1.Emergency Medicine and NeurosurgeryZucker School of Medicine at Hofstra/NorthwellHempsteadUSA
  2. 2.Herbert Wertheim College of MedicineFlorida International University, MiamiFLUSA
  3. 3.Emergency Medicine and Neurosurgery Stony Brook University School of MedicineStony BrookUSA

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