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Hemodynamic Monitoring and Fluid Management in ARDS

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Acute Respiratory Distress Syndrome

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Abstract

Acute respiratory distress syndrome (ARDS) is a major cause of morbidity and mortality in the ICU affecting as many as 10% of critically ill patients and almost a quarter of mechanically ventilated patients [1, 2]. ARDS is characterized by increased permeability of the alveolar-capillary membrane due to dysregulated, tissue-destructive inflammation. Pulmonary edema, the result of fluid maldistribution, has an adverse impact on respiratory function at several levels including decreased lung compliance, impaired gas exchange, reduction of surfactant levels, and pulmonary hypertension [3]. In the early phase of ARDS, a systemic inflammatory state is usually responsible for hypovolemia. In this phase, early and adequate fluid resuscitation is essential to prevent the development of multiorgan dysfunction, which can impact mortality in patients with ARDS [4]. As the inflammatory state resolves, the excessive fluid can have a detrimental impact on patient outcome. Transition from one phase to another is complex and can often be difficult to distinguish. However, identifying the transition between these two phases is likely to be important for optimization of fluid balance and improving patient outcomes.

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  1. Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital/Harvard Medical School, Boston, MA, USA

    Dusan Hanidziar MD, PhD & Edward A. Bittner MD, PhD

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  1. Dusan Hanidziar MD, PhD
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  2. Edward A. Bittner MD, PhD
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Correspondence to Dusan Hanidziar MD, PhD .

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  1. Department of "Scienze della Salute", University of Milan, Director of Anaesthesia and Intensive Care Services , ASST Santi Paolo e Carlo, Milan, Italy

    Davide Chiumello

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Hanidziar, D., Bittner, E.A. (2017). Hemodynamic Monitoring and Fluid Management in ARDS. In: Chiumello, D. (eds) Acute Respiratory Distress Syndrome. Springer, Cham. https://doi.org/10.1007/978-3-319-41852-0_8

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