Acute respiratory distress syndrome

Motivated by reading the article published in The BMJ on 16 November 2017, by John G Laffey and Brian P Kavanagh: Acute Respiratory Distress Syndrome, as Professors of Intensive Care Medicine and Emergencies, we wish to make some comments that alert all medical professionals to improve the prognosis of patients affected by this syndrome.

As recognized in the article, it was recognized as an individual clinical entity from the original description of Ashbaug, Petty and collaborators in 1967.
It is associated with high mortality and morbidity. It has a high cost, both economically and in human lives.

The Acute Respiratory Distress Syndrome is a condition that involves the pulmonary parenchyma, where there is a rapid and progressive alteration in the permeability of the alveolar-capillary set with progressive increase of hypoxemia and hypercapnia is produced and the formation of a hyaline membrane is added. Finally it evolves to a respiratory failure of difficult reversal.

Whatever the cause that leads a patient to suffer from Acute Respiratory Distress Syndrome, the Goal-Standard of treatment is the use of optimal and punctual ventilatory parameters.

We wish to emphasize that its timely diagnosis in emergency services may favor its prognosis, since it does not develop as an isolated process in the course of a well-defined illness. This implies that the best way to prevent its development is to diagnose it opportunely, to control the causes that trigger it, if possible, adequate and early control of sepsis, hemorrhages and other frequent causes.

We must not forget that to prevent pulmonary complications an adequate technique of respiratory support is essential, the correct humidification of the inspired mixture, together with physical thoracic therapy, will avoid the retention of secretions and will facilitate a correct distribution of ventilation in relation with perfusion.

Unfortunately, about 40 percent of people with Acute Respiratory Distress Syndrome die due to organ failure. However, the risk of death is not the same for all patients with Acute Respiratory Distress Syndrome. The mortality rate is linked both to the cause of the Acute Respiratory Distress Syndrome and to the general health of the patient. Many people who survive the Acute Respiratory Distress Syndrome recover completely within a few months. However, in some people the lung damage is sustained for life. Other side effects may include muscle weakness, fatigue, reduced quality of life and mental health commitment.

The characteristic of the natural evolution of the Acute Respiratory Distress Syndrome requires early identification of patients at risk, an early diagnosis, a multidisciplinary study with imaging support and prompt and effective treatment with particular emphasis on the optimization of respiratory parameters during mechanical ventilation

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