Sbaraini Zernini Irene, Nocera Domenico, D'Albo Rosanna, Tonetti Tommaso
Department of Medical and Surgical Sciences (DIMEC), Alma Mater Studiorum University of Bologna, 40126 Bologna, Italy.
Anesthesiology and General Intensive Care Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40126 Bologna, Italy.
J Clin Med. 2025 Mar 18;14(6):2067. doi: 10.3390/jcm14062067.
ARDS is a challenging syndrome in which the hallmark is alveolar epithelium damage, with the consequent extravasation of fluids into the interstitium and alveolar space. Patients with severe ARDS almost always require mechanical ventilation and aggressive fluid resuscitation, at least in the initial phases. The increased intrathoracic pressure during positive pressure ventilation reduces cardiac output, worsening the circulatory status of these patients even more. In this pathological context, fluid therapies serve as a means to restore intravascular volume but can simultaneously play a detrimental role, increasing the amount of liquid in the lungs and worsening gas exchange and lung mechanics. Indeed, clinical research suggests that fluid overload leads to worsening outcomes, mostly in terms of gas exchange, days of mechanical ventilation, and ICU stay duration. For these reasons, this review aims to provide basic information about ARDS pathophysiology and heart-lung interactions, the understanding of which is essential to guide fluid therapy, together with the close monitoring of hemodynamics and fluid responsiveness.
急性呼吸窘迫综合征（ARDS）是一种具有挑战性的综合征，其特征是肺泡上皮损伤，进而导致液体渗入间质和肺泡腔。重度ARDS患者几乎总是需要机械通气和积极的液体复苏，至少在初始阶段如此。正压通气期间胸腔内压力升高会降低心输出量，进一步恶化这些患者的循环状态。在这种病理情况下，液体疗法是恢复血管内容量的一种手段，但同时可能起到有害作用，增加肺内液体量，恶化气体交换和肺力学。事实上，临床研究表明，液体超负荷会导致预后恶化，主要体现在气体交换、机械通气天数和重症监护病房（ICU）住院时间方面。出于这些原因，本综述旨在提供有关ARDS病理生理学和心肺相互作用的基本信息，对其的理解对于指导液体疗法以及密切监测血流动力学和液体反应性至关重要。
