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ARDS: Current Concepts

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Sepsis

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Summary

As in other critical care fields, the past 5 years have been rich with good news about adult respiratory distress syndrome (ARDS). New epidemiologic data concerning incidence and outcome in different countries have been published. Components of the ARDS definition are being clarified. The influence of genetics is beginning to be studied. Risk factors are grouped according to pathophysiologic characteristics. Techniques such as computed tomography (CT) not only give data about lung morphology in different stages of ARDS, but also provide information about response to therapy. Mechanisms of repair continue to be clarified. And, above all, there are new insights about essential supportive therapy, mechanical ventilation. Limitation of tidal volumes has been associated with an improved outcome, possibly because of protecting from overdistention and subsequent ventilator-induced lung injury. New methods to titrate positive end-expiratory pressure (PEEP) have been proposed, but none has shown a clear advantage over the others. PEEP has been associated with a protective effect against ventilator-induced lung injury (VILI), well demonstrated in experimental studies but still uncertain in clinical trials. Of the new adjunctive measures for mechanical ventilation, prone positioning and recruitment maneuvers have been most extensively studied, especially with regard to their mechanisms of action, and are physiologically appealing. Prone positioning is an inexpensive and effective method for reversing hypoxemia, but effects on mortality have not been demonstrated, possibly because the timing and duration of this adjuvant have not been established yet. Recruitment maneuvers are starting to be used in the clinical arena; data about optimal frequency, duration, magnitude, and impact on outcome are still lacking.

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Authors
  1. Elisa Estenssoro
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  2. Arnaldo Dubin
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  3. Fernando Pálizas
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Editors and Affiliations

  1. Universidad del Bosque, Bogotá, Colombia

    Guillermo Ortiz-Ruiz MD (Professor of Pulmonary and Critical Care Medicine) (Professor of Pulmonary and Critical Care Medicine)

  2. Fundacion Clinica Shaio, Bogotá, Colombia

    Marco A. Perafán MD (Professor of Cardiology and Critical Care Medicine) (Professor of Cardiology and Critical Care Medicine)

  3. Department of Surgery, Klinikum Grosshadern, University of Munich, Munich, Germany

    Eugen Faist MD (Professor) (Professor)

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Estenssoro, E., Dubin, A., Pálizas, F. (2004). ARDS: Current Concepts. In: Ortiz-Ruiz, G., Perafán, M.A., Faist, E. (eds) Sepsis. Springer, New York, NY. https://doi.org/10.1007/978-1-4757-3824-7_10

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  • DOI: https://doi.org/10.1007/978-1-4757-3824-7_10

  • Publisher Name: Springer, New York, NY

  • Print ISBN: 978-0-387-20451-2

  • Online ISBN: 978-1-4757-3824-7

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