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The Acute Respiratory Distress Syndrome: Diagnosis and Management

  • Davide Chiumello
  • Antonella Marino
  • Antonio Cammaroto
Chapter

Abstract

Acute respiratory distress syndrome (ARDS) is characterized by a new acute onset of hypoxemia secondary to a pulmonary edema of non-cardiogenic origin, bilateral lung opacities and reduction in respiratory system compliance after an insult direct or indirect to lungs. Its first description was in 1970s, and then several shared definitions tried to describe this clinical entity; the last one, known as Berlin definition, brought an improvement in predictive ability for mortality.

In the present chapter, the diagnostic workup of the syndrome will be presented with particular attention to microbiological investigations which represent a milestone in the diagnostic process and to imaging techniques such as CT scan and lung ultrasound.

Despite the treatment is mainly based on supportive strategies, attention should be applied to assure adequate respiratory gas exchange while minimizing the risk of ventilator-induced lung injury (VILI) onset. Therefore will be described several therapeutic approaches to ARDS, including noninvasive mechanical ventilation (NIMV), high-flow nasal cannulas (HFNC) and invasive ventilation with particular emphasis to risks and benefits of mechanical ventilation, PEEP optimization and lung protective ventilation strategies. Rescue techniques, such as permissive hypercapnia, prone positioning, neuromuscular blockade, inhaled vasodilators, corticosteroids, recruitment maneuvers and extracorporeal life support, will also be reviewed.

Finally, the chapter will deal with the mechanical ventilation weaning process with particular emphasis on extrapulmonary factors such as neurologic, diaphragmatic or cardiovascular alterations which can lead to weaning failure.

Keywords

ARDS Lung CT scan Lung ultrasound Ventilator-induced lung injury Recruitment maneuver PEEP titration Protective ventilation Permissive hypercapnia Prone positioning Weaning process 

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Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  • Davide Chiumello
    • 1
  • Antonella Marino
    • 2
  • Antonio Cammaroto
    • 3
  1. 1.Intensive TherapyUniversity of Milan San Paolo HospitalMilanItaly
  2. 2.UOC Anestesia e Rianimazione, Ospedale San PaoloASST Santi Paolo e CarloMilanItaly
  3. 3.Dipartimento di Fisiopatologia Medico-Chirurgica e dei TrapiantiUniversità degli Studi di MilanoMilanItaly

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