ARDS/ALI

Definition

Pathophysiology

Acute Phase

Figure 1: Pathophysiology of ARDS (Ware et al, NEJM 2000)


Resolution Phase

Fibrosing Phase

Treatment

Figure 2: Adult ARDSNet Protocol For Reference (not primarily used in the PICU)

Adjunct Therapies

References

1) G.R. Bernard, A. Artigas, K.L. Brigham, et al.: The Consensus Committee. The American-European consensus conference on ARDS: definitions, mechanisms, relevant outcomes, and clinical trial coordination. Am J Respir Crit Care Med. 149:818-824 1994 7509706

2) ARDS Definition Task Force, Ranieri VM, Rubenfeld GD, Thompson BT, FergusonND, Caldwell E, Fan E, Camporota L, Slutsky AS. Acute respiratory distress syndrome: the Berlin Definition. JAMA. 2012 Jun 20;307(23):2526-33. doi: 10.1001/jama.2012.5669. PubMed PMID: 22797452.

3) Ventilation with lower tidal volumes as compared with traditional tidalvolumes for acute lung injury and the acute respiratory distress syndrome. The Acute Respiratory Distress Syndrome Network. N Engl J Med. 2000 May 4;342(18):1301-8. PubMed PMID: 10793162.

4) ARDS Clinical Trials Network: Higher versus lower positive end-expiratory pressures in patients with the acute respiratory distress syndrome. N Engl J Med. 351:327-3362004

5) Guérin C, Reignier J, Richard JC, Beuret P, Gacouin A, Boulain T, Mercier E,Badet M, Mercat A, Baudin O, Clavel M, Chatellier D, Jaber S, Rosselli S, Mancebo J, Sirodot M, Hilbert G, Bengler C, Richecoeur J, Gainnier M, Bayle F, Bourdin G, Leray V, Girard R, Baboi L, Ayzac L; PROSEVA Study Group. Prone positioning in severe acute respiratory distress syndrome. N Engl J Med. 2013 Jun 6;368(23):2159-68. doi: 10.1056/NEJMoa1214103. Epub 2013 May 20. PubMed PMID: 23688302.

6) 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 Jul 7;(7):CD002787. doi: 10.1002/14651858.CD002787.pub2. Review. PubMed PMID: 20614430.

7) J.H. Arnold, J.H. Hanson, L.O. Togo-Figuero:Prospective, randomized comparison of high-frequency oscillatory ventilation and conventional mechanical ventilation in pediatric respiratory failure. Crit Care Med.22:1530-1539 1994 7924362

8) Ferguson ND, Cook DJ, Guyatt GH, Mehta S, Hand L, Austin P, Zhou Q, Matte A,Walter SD, Lamontagne F, Granton JT, Arabi YM, Arroliga AC, Stewart TE, SlutskyAS, Meade MO; OSCILLATE Trial Investigators; Canadian Critical Care Trials Group.High-frequency oscillation in early acute respiratory distress syndrome. N Engl JMed. 2013 Feb 28;368(9):795-805. doi: 10.1056/NEJMoa1215554. Epub 2013 Jan 22.PubMed PMID: 23339639.

9) Young D, Lamb SE, Shah S, MacKenzie I, Tunnicliffe W, Lall R, Rowan K, Cuthbertson BH; OSCAR Study Group. High-frequency oscillation for acuterespiratory distress syndrome. N Engl J Med. 2013 Feb 28;368(9):806-13. doi:10.1056/NEJMoa1215716. Epub 2013 Jan 22. PubMed PMID: 23339638.

10) Peek GJ, Mugford M, Tiruvoipati R, Wilson A, Allen E, Thalanany MM, HibbertCL, Truesdale A, Clemens F, Cooper N, Firmin RK, Elbourne D; CESAR trialcollaboration. Efficacy and economic assessment of conventional ventilatorysupport versus extracorporeal membrane oxygenation for severe adult respiratoryfailure (CESAR): a multicentre randomised controlled trial. Lancet. 2009 Oct17;374(9698):1351-63. doi: 10.1016/S0140-6736(09)61069-2. Epub 2009 Sep 15.Erratum in: Lancet. 2009 Oct 17;374(9698):1330. PubMed PMID: 19762075.http://content.nejm.org/cgi/reprint/354/16/1671.pdf

11) Meduri GU, Headley AS, Golden E, Carson SJ, Umberger RA, Kelso T et al. Effect of prolonged methylprednisolone therapy in unresolving acute respiratory distress syndrome: a randomized controlled trial. JAMA 1998; 280(2):159-165.

12) Steinberg KP, Hudson LD, Goodman RB, et al. Efficacy and safety of corticosteroids for persistent acute respiratory distress syndrome. N Engl J Med 2006; 354:1671-84.

13) Papazian L, Forel JM, Gacouin A, Penot-Ragon C, Perrin G, Loundou A, Jaber S, Arnal JM, Perez D, Seghboyan JM, Constantin JM, Courant P, Lefrant JY, Guérin C, Prat G, Morange S, Roch A; ACURASYS Study Investigators. Neuromuscular blockersin early acute respiratory distress syndrome. N Engl J Med. 2010 Sep16;363(12):1107-16. doi: 10.1056/NEJMoa1005372. PubMed PMID: 20843245.

14) National Heart, Lung, and Blood Institute Acute Respiratory Distress Syndrome (ARDS) Clinical Trials Network, Wiedemann HP, Wheeler AP, Bernard GR, ThompsonBT, Hayden D, deBoisblanc B, Connors AF Jr, Hite RD, Harabin AL. Comparison oftwo fluid-management strategies in acute lung injury. N Engl J Med. 2006 Jun15;354(24):2564-75. Epub 2006 May 21. PubMed PMID: 16714767.

15) A. Anzueto, R.P. Baughman, K.K. Guntupalli: For the Exosurf actute respiratory distress syndrome sepsis study group. Aerosolized surfactant in adults with sepsis-induced acute respiratory distress syndrome. N Engl J Med. 334:1417-1421 1996 8618579

16) Willson DF, Thomas NJ, Markovitz BP, Bauman LA, DiCarlo JV, Pon S, Jacobs BR, Jefferson LS, Conaway MR, Egan EA; Pediatric Acute Lung Injury and SepsisInvestigators. Effect of exogenous surfactant (calfactant) in pediatric acutelung injury: a randomized controlled trial. JAMA. 2005 Jan 26;293(4):470-6.

17) Willson DF, Thomas NJ, Tamburro R, Truemper E, Truwit J, Conaway M, Traul C,Egan EE; Pediatric Acute Lung and Sepsis Investigators Network. Pediatriccalfactant in acute respiratory distress syndrome trial. Pediatr Crit Care Med.2013 Sep;14(7):657-65.

18) Amato MB, Meade MO, Slutsky AS, Brochard L, Costa EL, Schoenfeld DA, StewartTE, Briel M, Talmor D, Mercat A, Richard JC, Carvalho CR, Brower RG. Drivingpressure and survival in the acute respiratory distress syndrome. N Engl J Med.2015 Feb 19;372(8):747-55.

19) Fan E, Brodie D, Slutsky A. ARDS Review. JAMA 2018