Department of Intensive Care Medicine, Inselspital, Bern, University Hospital, University of Bern, Freiburgstrasse, CH-3010 Bern, Switzerland.
Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA 02115, USA.
Best Pract Res Clin Anaesthesiol. 2021 Oct;35(3):351-368. doi: 10.1016/j.bpa.2020.12.011. Epub 2020 Dec 17.
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) induces coronavirus-19 disease (COVID-19) and is a major health concern. Following two SARS-CoV-2 pandemic "waves," intensive care unit (ICU) specialists are treating a large number of COVID19-associated acute respiratory distress syndrome (ARDS) patients. From a pathophysiological perspective, prominent mechanisms of COVID19-associated ARDS (CARDS) include severe pulmonary infiltration/edema and inflammation leading to impaired alveolar homeostasis, alteration of pulmonary physiology resulting in pulmonary fibrosis, endothelial inflammation (endotheliitis), vascular thrombosis, and immune cell activation. Although the syndrome ARDS serves as an umbrella term, distinct, i.e., CARDS-specific pathomechanisms and comorbidities can be noted (e.g., virus-induced endotheliitis associated with thromboembolism) and some aspects of CARDS can be considered ARDS "atypical." Importantly, specific evidence-based medical interventions for CARDS (with the potential exception of corticosteroid use) are currently unavailable, limiting treatment efforts to mostly supportive ICU care. In this article, we will discuss the underlying pulmonary pathophysiology and the clinical management of CARDS. In addition, we will outline current and potential future treatment approaches.
严重急性呼吸综合征冠状病毒 2（SARS-CoV-2）可引起冠状病毒病（COVID-19），是一个主要的健康关注点。在经历了两次 SARS-CoV-2 大流行“浪潮”后，重症监护病房（ICU）专家正在治疗大量 COVID-19 相关的急性呼吸窘迫综合征（ARDS）患者。从病理生理学的角度来看，COVID-19 相关 ARDS（CARDS）的主要机制包括严重的肺部浸润/水肿和炎症导致肺泡稳态受损、改变肺生理导致肺纤维化、内皮炎症（内皮炎）、血管血栓形成和免疫细胞激活。尽管综合征 ARDS 是一个总称，但可以注意到不同的，即 CARDS 特异性的发病机制和合并症（例如，病毒诱导的内皮炎与血栓栓塞相关），并且 CARDS 的某些方面可以被认为是 ARDS 的“非典型”。重要的是，目前针对 CARDS 的特定循证医学干预措施（皮质类固醇的使用除外）尚不可用，这限制了治疗措施主要为支持性 ICU 护理。在本文中，我们将讨论 CARDS 的潜在肺部病理生理学和临床管理。此外，我们将概述当前和潜在的未来治疗方法。
