Clinic of Geriatric Medicine, Center of Geriatric Medicine and Rehabilitation, Kantonsspital Baselland, Bruderholz, Switzerland.
Department of Emergency Medicine, Inselspital, University Hospital, University of Bern, Bern, Switzerland.
Crit Care. 2024 May 27;28(1):179. doi: 10.1186/s13054-024-04966-4.
Acute respiratory distress syndrome (ARDS) represents a life-threatening inflammatory reaction marked by refractory hypoxaemia and pulmonary oedema. Despite advancements in treatment perspectives, ARDS still carries a high mortality rate, often due to systemic inflammatory responses leading to multiple organ dysfunction syndrome (MODS). Indeed, the deterioration and associated mortality in patients with acute lung injury (LI)/ARDS is believed to originate alongside respiratory failure mainly from the involvement of extrapulmonary organs, a consequence of the complex interaction between initial inflammatory cascades related to the primary event and ongoing mechanical ventilation-induced injury resulting in multiple organ failure (MOF) and potentially death. Even though recent research has increasingly highlighted the role of the gastrointestinal tract in this process, the pathophysiology of gut dysfunction in patients with ARDS remains mainly underexplored. This review aims to elucidate the complex interplay between lung and gut in patients with LI/ARDS. We will examine various factors, including systemic inflammation, epithelial barrier dysfunction, the effects of mechanical ventilation (MV), hypercapnia, and gut dysbiosis. Understanding these factors and their interaction may provide valuable insights into the pathophysiology of ARDS and potential therapeutic strategies to improve patient outcomes.
急性呼吸窘迫综合征（ARDS）代表了一种危及生命的炎症反应，其特征为难治性低氧血症和肺水肿。尽管在治疗观点上取得了进展，但 ARDS 仍然具有很高的死亡率，通常是由于全身性炎症反应导致多器官功能障碍综合征（MODS）。事实上，急性肺损伤（ALI）/ARDS 患者的病情恶化和相关死亡率被认为与呼吸衰竭同时发生，主要是由于肺外器官的参与，这是与原发性事件相关的初始炎症级联反应和持续机械通气诱导损伤之间复杂相互作用的结果，导致多器官衰竭（MOF）和潜在的死亡。尽管最近的研究越来越强调胃肠道在这一过程中的作用，但 ARDS 患者肠道功能障碍的病理生理学仍主要未得到充分探索。本综述旨在阐明 ALI/ARDS 患者肺部和肠道之间的复杂相互作用。我们将检查各种因素，包括全身炎症、上皮屏障功能障碍、机械通气（MV）的影响、高碳酸血症和肠道菌群失调。了解这些因素及其相互作用可能为 ARDS 的病理生理学和改善患者预后的潜在治疗策略提供有价值的见解。
