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About ARDS

Acute Respiratory Distress Syndrome is a lung injury specific to critically ill patients and manifested in a specific form. A major cause of morbidity and mortality in critically ill patients, ARDS is a syndrome of diffused lung inflammation and oedema ultimately leading to respiratory failure. Understanding its causes deeply and trying new treatment options may be the key to reduce mortality due to ARDS.

The Indian landscape of ARDS: Incidences, Etiology and Risk Factors

- Tropical infectious diseases in India showcases higher incidences of ARDS with a different aetiology

- The epidemiological profile of patients suffering from ARDS in India are as follows:

Defining ARDS

First described in 1967, ARDS was defined with characteristics-

  • New onset hypoxemia refractory to supplemental oxygen.
  • Bilateral infiltrates on chest radiograph.
  • Reduced respiratory system compliance.

Guidelines ARDS

Owing to new research and development in the field of ARDS, researchers wanted a need for an expanded definition with critical points such as:

Recent clinical trials in ARDS have used SpO2/FIO₂ (measured by pulse oximetry) as opposed to the PaO2/FiO2 ratio for patient selection while having similar outcomes for both.

Increased use of high flow nasal oxygen (HFNO) To manage severe hypoxemic respiratory failure during insufficient oxygen in the blood, the use of HFNO increased dramatically post successful trial results. HFNO was also widely used at peak of the COVID-19 pandemic, providing its usefulness further.

Using chest X-ultrasound instead of chest X-ray In the absence of X-rayequipment and in limited resources, the chest ultrasound performed by trained personnel can substitute for or serve as an adjunct to chest X-rays.

Added limitation of its requirement for invasive or non-invasive ventilation is not met in settings with non-availability of mechanical ventilation.

Challenges in ARDS

  1. Burden of mortality and post-discharge impaired functional ability and reduced exercise tolerance.

  2. Extracorporeal carbon dioxide removal is associated with bleeding complications and lacks sufficient data on efficacy.

  3. High frequency oscillatory ventilation does not improve ventilation.

  4. High-flow nasal canula oxygen therapy does not reduce mortality rates.

  5. Airway pressure release ventilation has no effect on the mortality rates.

The emerging pharmacological therapy in ARDS Aviptadil

Despite considerable advances in our knowledge regarding the pathophysiology of ARDS, insights into the biologic mechanisms of injury and lung repair and advances in supportive care including ventilatory management, lack of direct effective therapy looms large.

Unacceptably high mortality & morbidity underlines the need to continue to develop and test therapies for this devastating clinical condition.

Voice on ARDS

Dr. Yatin Mehta

Dr. Agam Vora

Dr. R.K. Gattani

Dr. Ashit Bhagwati

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Voice on ARDS