Anesthesiology. 2021 Feb 1;134(2):270-282. doi: 10.1097/ALN.0000000000003571.
Acute Respiratory Distress Syndrome (ARDS) is defined as the rapid onset of non-cardiogenic pulmonary edema resulting in respiratory failure and hypoxemia. Efforts over the past 25 years, such as those of the ARDS and Prevention and Early Treatment of Acute Lung Injury (PETAL) Networks, have demonstrated a praiseworthy collaboration to further optimize the management of ARDS. However, improvements have been only moderate and ARDS remains a leading cause of mortality in the perioperative and critical care setting. Recently, the significant morbidity and mortality of ARDS have been emphasized by its high incidence in Coronavirus Disease 2019 (COVID-19) patients. A major hurdle to reducing ARDS mortality is that current treatment is limited to preventive measures – such as the use of lung-protective ventilation. Therapeutic approaches targeting the underlying inflammatory lung disease are areas of intensive research, but have not been clinically implemented. Nevertheless, basic science and clinical research efforts that are aimed at identifying novel treatment approaches and further improving outcomes for ARDS are ongoing. Here, we review evidence-based management approaches for ARDS, while highlighting those being investigated or heavily utilized in ARDS associated with COVID-19.
急性呼吸窘迫综合征（ARDS）定义为非心源性肺水肿的快速发作，导致呼吸衰竭和低氧血症。在过去的 25 年中，人们进行了大量努力，例如 ARDS 和预防及早期治疗急性肺损伤（PETAL）网络的努力，展示了值得称赞的合作，以进一步优化 ARDS 的管理。然而，改善情况只是适度的，ARDS 仍然是围手术期和重症监护环境中死亡的主要原因。最近，ARDS 的高发病率强调了其在 2019 年冠状病毒病（COVID-19）患者中的严重发病率和死亡率。降低 ARDS 死亡率的主要障碍是目前的治疗仅限于预防措施，例如使用肺保护性通气。针对潜在炎症性肺病的治疗方法是密集研究的领域，但尚未在临床上实施。尽管如此，旨在确定新的治疗方法并进一步改善 ARDS 预后的基础科学和临床研究工作仍在进行中。在这里，我们回顾了 ARDS 的循证管理方法，同时强调了那些与 COVID-19 相关的 ARDS 正在研究或大量使用的方法。
