The Acute Respiratory Distress Syndrome
Authors: Claude A. Piantadosi, David A. Schwartz
Journal: Annals of Internal Medicine (2004)

Reviews21 September 2004The Acute Respiratory Distress SyndromeClaude A. Piantadosi, MD and David A. Schwartz, MD, MPHClaude A. Piantadosi, MDFrom Duke University Medical Center, Durham, North Carolina. and David A. Schwartz, MD, MPHFrom Duke University Medical Center, Durham, North Carolina.Author, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-141-6-200409210-00012 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail Clinical PrinciplesSevere respiratory distress and 1 or more risk factors (including infection, aspiration, pancreatitis, and trauma)Impaired arterial oxygenation (hypoxemia)Bilateral pulmonary infiltrates on chest radiographNo clinical evidence of elevated left atrial pressure (or pulmonary artery occlusion pressure of ≤ 18 mm Hg if measurements are available)Physiologic PrinciplesThe cardinal feature of ARDS, refractory hypoxemia, is caused by formation of protein-rich alveolar edema after damage to the integrity of the lung's alveolar-capillary barrier.Alveolar-capillary damage in ARDS can be initiated by physical or chemical injury or by extensive activation of innate inflammatory responses. Such damage causes the lung's edema safety factor to decrease by ...References1. Bernard GR, Artigas A, Brigham KL, Carlet J, Falke K, Hudson L, et al . The American-European Consensus Conference on ARDS. Definitions, mechanisms, relevant outcomes, and clinical trial coordination. Am J Respir Crit Care Med. 1994;149:818-24. [PMID: 7509706] CrossrefMedlineGoogle Scholar2. Hudson LD, Milberg JA, Anardi D, Maunder RJ. Clinical risks for development of the acute respiratory distress syndrome. Am J Respir Crit Care Med. 1995;151:293-301. [PMID: 7842182] CrossrefMedlineGoogle Scholar3. Ware LB, Matthay MA. The acute respiratory distress syndrome. N Engl J Med. 2000;342:1334-49. [PMID: 10793167] CrossrefMedlineGoogle Scholar4. Ashbaugh DG, Bigelow DB, Petty TL, Levine BE. Acute respiratory distress in adults. Lancet. 1967;2:319-23. [PMID: 4143721] CrossrefMedlineGoogle Scholar5. Hudson LD, Steinberg KP. Epidemiology of acute lung injury and ARDS. Chest. 1999;116:74S-82S. [PMID: 10424602] CrossrefMedlineGoogle Scholar6. Doyle RL, Szaflarski N, Modin GW, Wiener-Kronish JP, Matthay MA. Identification of patients with acute lung injury. Predictors of mortality. Am J Respir Crit Care Med. 1995;152:1818-24. [PMID: 8520742] CrossrefMedlineGoogle Scholar7. Zilberberg MD, Epstein SK. Acute lung injury in the medical ICU: comorbid conditions, age, etiology, and hospital outcome. Am J Respir Crit Care Med. 1998;157:1159-64. [PMID: 9563734] CrossrefMedlineGoogle Scholar8. Monchi M, Bellenfant F, Cariou A, Joly LM, Thebert D, Laurent I, et al . Early predictive factors of survival in the acute respiratory distress syndrome. A multivariate analysis. Am J Respir Crit Care Med. 1998;158:1076-81. [PMID: 9769263] CrossrefMedlineGoogle Scholar9. Luhr OR, Antonsen K, Karlsson M, Aardal S, Thorsteinsson A, Frostell CG, et al . Incidence and mortality after acute respiratory failure and acute respiratory distress syndrome in Sweden, Denmark, and Iceland. The ARF Study Group. Am J Respir Crit Care Med. 1999;159:1849-61. [PMID: 10351930] CrossrefMedlineGoogle Scholar10. Heffner JE, Brown LK, Barbieri CA, Harpel KS, DeLeo J. Prospective validation of an acute respiratory distress syndrome predictive score. Am J Respir Crit Care Med. 1995;152:1518-26. [PMID: 7582287] CrossrefMedlineGoogle Scholar11. Aberle DR, Wiener-Kronish JP, Webb WR, Matthay MA. Hydrostatic versus increased permeability pulmonary edema: diagnosis based on radiographic criteria in critically ill patients. Radiology. 1988;168:73-9. [PMID: 3380985] CrossrefMedlineGoogle Scholar12. Goodman LR. Congestive heart failure and adult respiratory distress syndrome. New insights using computed tomography. Radiol Clin North Am. 1996;34:33-46. [PMID: 8539352] MedlineGoogle Scholar13. Gattinoni L, Bombino M, Pelosi P, Lissoni A, Pesenti A, Fumagalli R, et al . Lung structure and function in different stages of severe adult respiratory distress syndrome. JAMA. 1994;271:1772-9. [PMID: 8196122] CrossrefMedlineGoogle Scholar14. Bachofen M, Weibel ER. Alterations of the gas exchange apparatus in adult respiratory insufficiency associated with septicemia. Am Rev Respir Dis. 1977;116:589-615. [PMID: 921049] CrossrefMedlineGoogle Scholar15. Bachofen M, Weibel ER. Structural alterations of lung parenchyma in the adult respiratory distress syndrome. Clin Chest Med. 1982;3:35-56. [PMID: 7075161] CrossrefMedlineGoogle Scholar16. Anderson WR, Thielen K. Correlative study of adult respiratory distress syndrome by light, scanning, and transmission electron microscopy. Ultrastruct Pathol. 1992;16:615-28. [PMID: 1448881] CrossrefMedlineGoogle Scholar17. Matthay MA, Wiener-Kronish JP. Intact epithelial barrier function is critical for the resolution of alveolar edema in humans. Am Rev Respir Dis. 1990;142:1250-7. [PMID: 2252240] CrossrefMedlineGoogle Scholar18. Elliott CG, Rasmusson BY, Crapo RO, Morris AH, Jensen RL. Prediction of pulmonary function abnormalities after adult respiratory distress syndrome (ARDS). Am Rev Respir Dis. 1987;135:634-8. [PMID: 3548507] MedlineGoogle Scholar19. Ghio AJ, Elliott CG, Crapo RO, Berlin SL, Jensen RL. Impairment after adult respiratory distress syndrome. An evaluation based on American Thoracic Society recommendations. Am Rev Respir Dis. 1989;139:1158-62. [PMID: 2712443] CrossrefMedlineGoogle Scholar20. Suchyta MR, Elliott CG, Jensen RL, Crapo RO. Predicting the presence of pulmonary function impairment in adult respiratory distress syndrome survivors. Respiration. 1993;60:103-8. [PMID: 8341851] CrossrefMedlineGoogle Scholar21. McHugh LG, Milberg JA, Whitcomb ME, Schoene RB, Maunder RJ, Hudson LD. Recovery of function in survivors of the acute respiratory distress syndrome. Am J Respir Crit Care Med. 1994;150:90-4. [PMID: 8025779] CrossrefMedlineGoogle Scholar22. Weinert CR, Gross CR, Kangas JR, Bury CL, Marinelli WA. Health-related quality of life after acute lung injury. Am J Respir Crit Care Med. 1997;156:1120-8. [PMID: 9351611] CrossrefMedlineGoogle Scholar23. 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;281:354-60. [PMID: 9929089] CrossrefMedlineGoogle Scholar24. Herridge MS, Cheung AM, Tansey CM, Matte-Martyn A, Diaz-Granados N, Al-Saidi F, et al . One-year outcomes in survivors of the acute respiratory distress syndrome. N Engl J Med. 2003;348:683-93. [PMID: 12594312] CrossrefMedlineGoogle Scholar25. Martin MA, Wenzel RP, Gorelick KJ. Gram-negative bacterial sepsis in hospitals in the United States–natural history in the 1980s. Prog Clin Biol Res. 1991;367:111-9. [PMID: 1924421] MedlineGoogle Scholar26. Medzhitov R, Janeway CA. Innate immunity: the virtues of a nonclonal system of recognition. Cell. 1997;91:295-8. [PMID: 9363937] CrossrefMedlineGoogle Scholar27. Medzhitov R, Janeway CA. Innate immunity: impact on the adaptive immune response. Curr Opin Immunol. 1997;9:4-9. [PMID: 9039775] CrossrefMedlineGoogle Scholar28. Wright SD. Toll, a new piece in the puzzle of innate immunity. J Exp Med. 1999;189:605-9. [PMID: 9989974] CrossrefMedlineGoogle Scholar29. Arbour NC, Lorenz E, Schutte BC, Zabner J, Kline JN, Jones M, et al . TLR4 mutations are associated with endotoxin hyporesponsiveness in humans. Nat Genet. 2000;25:187-91. [PMID: 10835634] CrossrefMedlineGoogle Scholar30. Lorenz E, Mira JP, Frees KL, Schwartz DA. Relevance of mutations in the TLR4 receptor in patients with gram-negative septic shock. Arch Intern Med. 2002;162:1028-32. [PMID: 11996613] CrossrefMedlineGoogle Scholar31. Piani A, Hossle JP, Birchler T, Siegrist CA, Heumann D, Davies G, et al . Expression of MHC class II molecules contributes to lipopolysaccharide responsiveness. Eur J Immunol. 2000;30:3140-6. [PMID: 11093128] CrossrefMedlineGoogle Scholar32. Takeuchi O, Takeda K, Hoshino K, Adachi O, Ogawa T, Akira S. Cellular responses to bacterial cell wall components are mediated through MyD88-dependent signaling cascades. Int Immunol. 2000;12:113-7. [PMID: 10607756] CrossrefMedlineGoogle Scholar33. Schromm AB, Lien E, Henneke P, Chow JC, Yoshimura A, Heine H, et al . Molecular genetic analysis of an endotoxin nonresponder mutant cell line: a point mutation in a conserved region of MD-2 abolishes endotoxin-induced signaling. J Exp Med. 2001;194:79-88. [PMID: 11435474] CrossrefMedlineGoogle Scholar34. West JB. State of the art: ventilation-perfusion relationships. Am Rev Respir Dis. 1977;116:919-43. [PMID: 921067] MedlineGoogle Scholar35. Taylor AE, Barnard JW, Barman SA, Adkins WK. Fluid balance.. In: Crystal RG, West JC, eds. The Lung: Scientific Foundations. New York: Raven Pr; 1991:1147-61. Google Scholar36. Guyton AC, Taylor AE, Granger HI. Circulatory Physiology II: Dynamics and Control of Body Fluids. Philadelphia: WB Saunders; 1975:149-93. Google Scholar37. Staub NC. Pathophysiology of pulmonary edema.. In: Staub NC, Taylor AE, eds. Edema. New York: Raven Pr; 1984:719-86. Google Scholar38. Vreim CE, Snashall PD, Staub NC. Protein composition of lung fluids in anesthetized dogs with acute cardiogenic edema. Am J Physiol. 1976;231:1466-9. [PMID: 998790] CrossrefMedlineGoogle Scholar39. Siflinger-Birnboim A, Johnson A. Protein kinase C modulates pulmonary endothelial permeability: a paradigm for acute lung injury. Am J Physiol Lung Cell Mol Physiol. 2003;284:L435-51. [PMID: 12573983] CrossrefMedlineGoogle Scholar40. Rinaldo JE, Rogers RM. Adult respiratory-distress syndrome: changing concepts of lung injury and repair. N Engl J Med. 1982;306:900-9. [PMID: 7038493] CrossrefMedlineGoogle Scholar41. Pittet JF, Mackersie RC, Martin TR, Matthay MA. Biological markers of acute lung injury: prognostic and pathogenetic significance. Am J Respir Crit Care Med. 1997;155:1187-205. [PMID: 9105054] CrossrefMedlineGoogle Scholar42. Cines DB, Pollak ES, Buck CA, Loscalzo J, Zimmerman GA, McEver RP, et al . Endothelial cells in physiology and in the pathophysiology of vascular disorders. Blood. 1998;91:3527-61. [PMID: 9572988] MedlineGoogle Scholar43. Albertine KH. Histopathology of Pulmonary Edema and the Acute Respiratory Distress Syndrome: Pulmonary Edema. New York: Marcel Dekker; 1998:37-83. Google Scholar44. Luscinskas FW, Gimbrone MA. Endothelial-dependent mechanisms in chronic inflammatory leukocyte recruitment. Annu Rev Med. 1996;47:413-21. [PMID: 8712792] CrossrefMedlineGoogle Scholar45. Zimmerman G, McIntyre T, Prescott S. Cell-to-cell communication.. In: Crystal RG, West JB, Barnes PJ, Weibel ER, eds. The Lung: Scientific Foundations. 2nd ed. Philadelphia: Lippincott–Raven; 1996:289-304. Google Scholar46. Hogg JC, Doerschuk CM. Leukocyte traffic in the lung. Annu Rev Physiol. 1995;57:97-114. [PMID: 7778886] CrossrefMedlineGoogle Scholar47. Zimmerman GA, Renzetti AD, Hill HR. Granulocyte adherence in pulmonary and systemic arterial blood samples from patients with adult respiratory distress syndrome. Am Rev Respir Dis. 1984;129:798-804. [PMID: 6721278] CrossrefMedlineGoogle Scholar48. Idell S. Endothelium and disordered fibrin turnover in the injured lung: newly recognized pathways. Crit Care Med. 2002;30:S274-80. [PMID: 12004248] CrossrefMedlineGoogle Scholar49. Martin TR. Neutrophils and lung injury: getting it right. J Clin Invest. 2002;110:1603-5. [PMID: 12464663] CrossrefMedlineGoogle Scholar50. Sakamaki F, Ishizaka A, Handa M, Fujishima S, Urano T, Sayama K, et al . Soluble form of P-selectin in plasma is elevated in acute lung injury. Am J Respir Crit Care Med. 1995;151:1821-6. [PMID: 7539327] CrossrefMedlineGoogle Scholar51. Grissom CK, Zimmerman GA, Whatley RE. Endothelial selectins in acute mountain sickness and high-altitude pulmonary edema. Chest. 1997;112:1572-8. [PMID: 9404756] CrossrefMedlineGoogle Scholar52. Donnelly SC, Haslett C, Dransfield I, Robertson CE, Carter DC, Ross JA, et al . Role of selectins in development of adult respiratory distress syndrome. Lancet. 1994;344:215-9. [PMID: 7518025] CrossrefMedlineGoogle Scholar53. Berthiaume Y, Lesur O, Dagenais A. Treatment of adult respiratory distress syndrome: plea for rescue therapy of the alveolar epithelium. Thorax. 1999;54:150-60. [PMID: 10325922] CrossrefMedlineGoogle Scholar54. Adamson IY, Hedgecock C, Bowden DH. Epithelial cell-fibroblast interactions in lung injury and repair. Am J Pathol. 1990;137:385-92. [PMID: 1696785] MedlineGoogle Scholar55. Johnson MD, Widdicombe JH, Allen L, Barbry P, Dobbs LG. Alveolar epithelial type I cells contain transport proteins and transport sodium, supporting an active role for type I cells in regulation of lung liquid homeostasis. Proc Natl Acad Sci U S A. 2002;99:1966-71. [PMID: 11842214] CrossrefMedlineGoogle Scholar56. Verkman AS. Water transport and molecular water channels in lung.. In: Matthay MA, Ingbar DH, eds. Pulmonary Edema. New York: Marcel Dekker; 1998:525-47. Google Scholar57. Borok Z, Lubman RL, Danto SI, Zhang XL, Zabski SM, King LS, et al . Keratinocyte growth factor modulates alveolar epithelial cell phenotype in vitro: expression of aquaporin 5. Am J Respir Cell Mol Biol. 1998;18:554-61. [PMID: 9533944] CrossrefMedlineGoogle Scholar58. Dobbs LG, Gonzalez R, Matthay MA, Carter EP, Allen L, Verkman AS. Highly water-permeable type I alveolar epithelial cells confer high water permeability between the airspace and vasculature in rat lung. Proc Natl Acad Sci U S A. 1998;95:2991-6. [PMID: 9501203] CrossrefMedlineGoogle Scholar59. Matthay MA, Folkesson HG, Verkman AS. Salt and water transport across alveolar and distal airway epithelia in the adult lung. Am J Physiol. 1996;270:L487-503. [PMID: 8928808] MedlineGoogle Scholar60. Maron MB, Holcomb PH, Dawson CA, Rickaby DA, Clough AV, Linehan JH. Edema development and recovery in neurogenic pulmonary edema. J Appl Physiol. 1994;77:1155-63. [PMID: 7836117] CrossrefMedlineGoogle Scholar61. Tanswell AK, Byrne PJ, Han RN, Edelson JD, Han VK. Limited division of low-density adult rat type II pneumocytes in serum-free culture. Am J Physiol. 1991;260:L395-402. [PMID: 2058685] MedlineGoogle Scholar62. Panos RJ. Cytokines and alveolar type II cells.. In: Kelley J, eds. Cytokines of the Lung. New York: Marcel Dekker; 1993:417-56. Google Scholar63. Post M, Souza P, Liu J, Tseu I, Wang J, Kuliszewski M, et al . Keratinocyte growth factor and its receptor are involved in regulating early lung branching. Development. 1996;122:3107-15. [PMID: 8898224] CrossrefMedlineGoogle Scholar64. Yanagita K, Matsumoto K, Sekiguchi K, Ishibashi H, Niho Y, Nakamura T. Hepatocyte growth factor may act as a pulmotrophic factor on lung regeneration after acute lung injury. J Biol Chem. 1993;268:21212-7. [PMID: 8407957] CrossrefMedlineGoogle Scholar65. Lesur O, Melloni B, Cantin AM, Bégin R. Silica-exposed lung fluids have a proliferative activity for type II epithelial cells: a study on human and sheep alveolar fluids. Exp Lung Res. 1992;18:633-54. [PMID: 1327731] CrossrefMedlineGoogle Scholar66. Chesnutt AN, Kheradmand F, Folkesson HG, Alberts M, Matthay MA. Soluble transforming growth factor-alpha is present in the pulmonary edema fluid of patients with acute lung injury. Chest. 1997;111:652-6. [PMID: 9118703] CrossrefMedlineGoogle Scholar67. Panos RJ, Rubin JS, Csaky KG, Aaronson SA, Mason RJ. Keratinocyte growth factor and hepatocyte growth factor/scatter factor are heparin-binding growth factors for alveolar type II cells in fibroblast-conditioned medium. J Clin Invest. 1993;92:969-77. [PMID: 7688769] CrossrefMedlineGoogle Scholar68. Ulich TR, Yi ES, Longmuir K, Yin S, Biltz R, Morris CF, et al . Keratinocyte growth factor is a growth factor for type II pneumocytes in vivo. J Clin Invest. 1994;93:1298-306. [PMID: 8132770] CrossrefMedlineGoogle Scholar69. Panos RJ, Bak PM, Simonet WS, Rubin JS, Smith LJ. Intratracheal instillation of keratinocyte growth factor decreases hyperoxia-induced mortality in rats. J Clin Invest. 1995;96:2026-33. [PMID: 7560096] CrossrefMedlineGoogle Scholar70. Yi ES, Salgado M, Williams S, Kim SJ, Masliah E, Yin S, et al . Keratinocyte growth factor decreases pulmonary edema, transforming growth factor-beta and platelet-derived growth factor-BB expression, and alveolar type II cell loss in bleomycin-induced lung injury. Inflammation. 1998;22:315-25. [PMID: 9604718] CrossrefMedlineGoogle Scholar71. Newman V, Gonzalez RF, Matthay MA, Dobbs LG. A novel alveolar type I cell-specific biochemical marker of human acute lung injury. Am J Respir Crit Care Med. 2000;161:990-5. [PMID: 10712353] CrossrefMedlineGoogle Scholar72. Sakuma T, Folkesson HG, Suzuki S, Okaniwa G, Fujimura S, Matthay MA. Beta-adrenergic agonist stimulated alveolar fluid clearance in ex vivo human and rat lungs. Am J Respir Crit Care Med. 1997;155:506-12. [PMID: 9032186] CrossrefMedlineGoogle Scholar73. Dreyfuss D, Saumon G. Ventilator-induced lung injury: lessons from experimental studies. Am J Respir Crit Care Med. 1998;157:294-323. [PMID: 9445314] CrossrefMedlineGoogle Scholar74. Slutsky AS, Tremblay LN. Multiple system organ failure. Is mechanical ventilation a contributing factor? Am J Respir Crit Care Med. 1998;157:1721-5. [PMID: 9620897] CrossrefMedlineGoogle Scholar75. Brower RG, Ware LB, Berthiaume Y, Matthay MA. Treatment of ARDS. Chest. 2001;120:1347-67. [PMID: 11591581] CrossrefMedlineGoogle Scholar76. 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;342:1301-8. [PMID: 10793162] CrossrefMedlineGoogle Scholar77. Eichacker PQ, Gerstenberger EP, Banks SM, Cui X, Natanson C. Meta-analysis of acute lung injury and acute respiratory distress syndrome trials testing low tidal volumes. Am J Respir Crit Care Med. 2002;166:1510-4. [PMID: 12406836] CrossrefMedlineGoogle Scholar78. Brower RG, Matthay M, Schoenfeld D. Meta-analysis of acute lung injury and acute respiratory distress syndrome trials [Letter]. Am J Respir Crit Care Med. 2002;166:1515-7. [PMID: 12450936] CrossrefMedlineGoogle Scholar79. Steinbrook R. Trial design and patient safety—the debate continues. N Engl J Med. 2003;349:629-30. [PMID: 12917298] CrossrefMedlineGoogle Scholar80. Cordingley JJ, Keogh BF. The pulmonary physician in critical care. 8: Ventilatory management of ALI/ARDS. Thorax. 2002;57:729-34. [PMID: 12149536] CrossrefMedlineGoogle Scholar Author, Article, and Disclosure InformationAffiliations: From Duke University Medical Center, Durham, North Carolina.Grant Support: By the National Heart, Lung, and Blood Institute, National Institutes of Health (PO1 HL 31992-18).Disclosures: None disclosed.Corresponding Author: Claude A. Piantadosi, MD, Division of Pulmonary and Critical Care Medicine, Box 3315, Duke University Medical Center, Durham, NC 27710; e-mail, [email protected]duke.edu.Current Author Addresses: Dr. Piantadosi: Division of Pulmonary and Critical Care Medicine, Box 3315, Duke University Medical Center, Durham, NC 27710.Dr. Schwartz: Division of Pulmonary and Critical Care Medicine, Box 2629, Duke University Medical Center, Durham, NC 27710. 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