Acute Respiratory Distress Syndrome (ARDS)-Part 1

History

In 1967, Ashbaugh Introduced the Term “Respiratory Distress Syndrome” to Describe a Clinical Syndrome with the Following Clinical Features (Lancet, 1967) [MEDLINE]

Acute Onset of Tachypnea (see Tachypnea)
Decreased Lung Compliance
Diffuse Pulmonary Infiltrates
High Short-Term Adult Mortality Rates
Hypoxemia (see Hypoxemia)

Epidemiology

Prevalence

LUNG SAFE Global Observational Study of Acute Respiratory Distress Syndrome (ARDS) in 50 Countries (JAMA, 2016) [MEDLINE]
- Epidemiology
  - Approximately 10.4% of ICU Admissions Met ARDS Criteria
  - Approximately 23.4% of Mechanically Ventilated Patients Met ARDS Criteria
- Clinical
  - Clinical Recognition of ARDS Ranged from 51.3% in Mild ARDS to 78.5% in Severe ARDS
- Therapy
  - Less Than 66% of the Patients Received Tidal Volume <8 mL/kg
  - Proning was Used in Only 16.3% of Patients with Severe ARDS
- Hospital Mortality Rates
  - Mild ARDS: 34.9%
  - Moderate ARDS: 40.3%
  - Severe ARDS: 46.1%
- Conclusions
  - ARDS Recognition and Management Has Room for Potential Clinical Improvement

Cost

Systematic Review of the Costs of Acute Respiratory Distress Syndrome (ARDS) (Chest, 2021) [MEDLINE]: n = 49,483 (from 22 studies)
- Mean Inpatient Costs Ranged from $8,476 (2021 US Dollars) to $547,974 (2021 US Dollars) and were Highest in Publications of Lower Quality and in American Health Systems and were Associated with Trauma Cohorts
- Mean Outpatient Costs were Highest in Publications with Higher Readmission Rates, Longer Durations of Follow-Up, and in American Health Systems

Risk Factors

Prediction of Acute Respiratory Distress Syndrome (ARDS) Using Clinical Factors

Lung Injury Prediction Score (LIPS) Study (Am J Respir Crit Care Med, 2011) [MEDLINE]: multicenter observational cohort study (n = 5,584 patients at risk)
- Acute Lung Injury Occurred at a Median of 2 Days in 6.8% of Patients
- Acute Lung Injury Can Be Predicted Early in the Course of Illness Using Clinical Parameters
  - Aspiration: LIPS points +2 pts
  - High-Risk Surgery (add 1.5 pts if emergency surgery)
    - Aortic/Vascular: +3.5 pts
    - Cardiac: +2.5 pts
    - Acute Abdomen: +2 pts
    - Orthopedic Spine: +1 pt
  - High-Risk Trauma
    - Traumatic Brain Injury: +2 pts
    - Smoke Inhalation: +2 pts
    - Near Drowning: +2 pts
    - Lung Contusion: +1.5 pts
    - Multiple Fractures: +1.5 pts
  - Pneumonia: +1.5 pts
  - Shock: +2 pts
  - Sepsis: +1 pt
  - Negative Risk Modifiers (Decrease the Risk of Acute Lung Injury)
    - Diabetes Mellitus: -1 pt (only if sepsis)
    - Note: Diabetes Mellitus is the Only Risk factor Which Decreases the Risk of Developing ARDS
  - Positive Risk Modifiers (Increase the Risk of Acute Lung Injury)
    - FIO2 >35%: +2 pts
    - pH <7.35: +1.5 pts
    - Tachypnea with RR >30: +1.5 pts
    - Alcohol Abuse: +1 pts
    - Obesity with BMI >30: +1 pt
    - Hypoalbuminemia: +1 pt
    - Chemotherapy: +1 pt
    - SpO2 <95%: +1 pt
- Scoring
  - Over 4 points (Optimal Cutoff Point in the Study Based on the Area Under the Curve Analysis): 69% sensitivity and 78% specificity for the prediction of development of ARDS

Prediction of Acute Respiratory Distress Syndrome (ARDS) Using Clinical Factors Present in the Emergency Department

Emergency Department Lung Injury Prediction Score Study (EDLIPS)/LIPS-1 Study (Int J Emerg Med, 2012) [MEDLINE]
- Incidence of Acute Lung Injury was 7%
- EDLIPS (Obtained Early in ED Course) Discriminated Patients Who Developed Acute Lung Injury Better than APACHE II Scoring and Similar to Original LIPS Score

Protective Factors

Older Age

Clinical Efficacy
- Prospective Multicenter Observational Cohort Study of Hospitalized Patients at Risk of Developing Acute Respiratory Distress Syndrome (ARDS) (from 3/09-8/09) (J Intensive Care Med, 2019) [MEDLINE]: n = 5,584 (22 hospitals)
  - Approximately 6.8% of the Patients Developed ARDS
  - After Adjusting for Severity of Illness and the Risk of ARDS Development Attributable to Other Factors, Older Adult Patients Had a Lower Incidence of ARDS, as Compared to Younger Patients (Odds Ratio: 0.28, 95% Confidence Interval: 0.18-0.42)

Corticosteroid Treatment (see Corticosteroids)

Clinical Efficacy
- Retrospective Study Examining the Effect of Preadmission Oral Corticosteroid on the Risk of Development of Acute Respiratory Distress Syndrome in Intensive Care Unit Patients with Sepsis (Crit Care Med, 2017) [MEDLINE]: n = 1080
  - Preadmission Oral Corticosteroid Use Decreases the Risk of Early Acute Respiratory Distress Syndrome (Within 96 hrs of ICU Admission) in ICU Patients with Sepsis (35%), as Compared to Patients Who Had Not Received Preadmission Corticosteroids (42%)
  - Higher Corticosteroid Doses (Prednisone 30 qday) were Associated with Lower Risk of ARDS (Odds Ratio 0.53) than were Lower Corticosteroid Doses (Prednisone 5 mg qday)
  - Preadmission Oral Corticosteroid Use Did Not Impact the In-Hospital Mortality Rate, ICU Length of Stay, or Ventilator-Free Days

Sodium-Glucose Cotransporter-2 (SGLT2) Inhibitors Treatment in the Setting of Diabetes Mellitus (see Sodium-Glucose Cotransporter-2 Inhibitors)

Clinical Efficacy
- South Korean Nationwide Cohort Study (2015-2020) of Sodium-Glucose Cotransporter-2 Inhibitors in Adult Patients with Type 2 Diabetes Mellitus (BMC Med, 2023) [MEDLINE]
  - Methods
    - 205,534 Patient Pairs (Mean Age: 53.8 y/o, 59% Male, Median F/U 0.66 yrs)
    - Primary Outcome was Respiratory Events Composite Endpoint
    - Secondary Outcomes were the Individual Components of the Primary Outcome and In-Hospital Death
    - Cox Models were Used to Estimate Hazard Ratios 95% Confidence Intervals
  - Incidence Rates for Overall Respiratory Events were 4.54 and 7.54 Per 1000 Person-Years Among Sodium-Glucose Cotransporter-2 (SGLT2) Inhibitors and Dipeptidyl Peptidase-4 (DPP-4) Inhibitors Users, Respectively, Corresponding to a Rate Difference of 3 Less Events Per 1000 Person-Years (95% CI – 3.44 to – 2.55)
  - Hazard Ratios (95% CIs)
    - 0.60 (0.55 to 0.64) for the Composite Respiratory Endpoint (Acute Pulmonary Edema, Acute Respiratory Distress Syndrome, Pneumonia, and Respiratory Failure
    - 0.35 (0.23 to 0.55) for Acute Pulmonary Edema
    - 0.44 (0.18 to 1.05) for Acute Respiratory Syndrome (ARDS)
    - 0.61 (0.56 to 0.66) for Pneumonia
    - 0.49 (0.31 to 0.76) for Respiratory Failure
    - 0.46 (0.41 to 0.51) for In-Hospital Death
  - Similar Trends were Found Across Individual Sodium-Glucose Cotransporter-2 (SGLT2) Inhibitors, Subgroup Analyses of Age, Sex, History of Comorbidities, and a Range of Sensitivity Analyses

Etiology

Infection

General

Sepsis (see Sepsis)
- Epidemiology
  - Sepsis is the Most Common Etiology of ARDS
- Risk Factors for the Development of Sepsis-Associated ARDS
  - Acute Abdomen (Ann Intensive Care, 2017) [MEDLINE]
  - Acute Pancreatitis (Ann Intensive Care, 2017) [MEDLINE]
  - Alcohol Abuse (Crit Care Med, 2003) [MEDLINE] and (Crit Care Med, 2008) [MEDLINE]
    - Ethanol May Decrease Glutathione Concentrations in the Epithelial Lining Fluid, Increasing the Risk of Oxidative iInjury to the Lung
  - Delayed Antibiotics (Crit Care Med, 2008) [MEDLINE]
  - Delayed Goal-Directed Resuscitation (Crit Care Med, 2008) [MEDLINE]
  - Diabetes Mellitus (Crit Care Med, 2008) [MEDLINE]
  - Higher APACHE II Score (Ann Intensive Care, 2017) [MEDLINE]
  - Higher Intravenous Fluid Resuscitation within the First 6 hrs (Ann Intensive Care, 2017) [MEDLINE]
    - In Stratified Analysis, the Total Fluid Infused within the First 6 hrs was a Risk Factor in the Non-Shock Group, But Not in the Shock Group
  - Increased Baseline Respiratory Rate (Crit Care Med, 2008) [MEDLINE]
  - Older Age (Ann Intensive Care, 2017) [MEDLINE]
  - Pneumonia as the Site of Infection (Ann Intensive Care, 2017) [MEDLINE]
  - Recent Chemotherapy (Crit Care Med, 2008) [MEDLINE]
  - Shock (Ann Intensive Care, 2017) [MEDLINE]
  - Transfusion (Crit Care Med, 2008) [MEDLINE]

Viral Pneumonia

Adenovirus (see Adenovirus)
Cytomegalovirus (CMV) (see Cytomegalovirus)
Epstein-Barr Virus (EBV) (see Epstein-Barr Virus)
Hantavirus (see Hantavirus Cardiopulmonary Syndrome)
Herpes Simplex Virus (HSV) (see Herpes Simplex Virus)
Influenza Virus (see Influenza Virus)
Measles Virus (see Measles Virus)
Human Metapneumovirus (see Human Metapneumovirus)
Middle East Respiratory Syndrome Corona Virus (MERS-CoV) (see Middle East Respiratory Syndrome Coronavirus)
Respiratory Syncytial Virus (RSV) (see Respiratory Syncytial Virus)
Severe Acute Respiratory Syndrome Coronavirus (SARS-CoV) (see Severe Acute Respiratory Syndrome Coronavirus)
Severe Acute Respiratory Syndrome Coronavirus (SARS-CoV2) (aka Coronavirus Disease 2019, COVID-19) (see Coronavirus Disease 2019)
Varicella-Zoster Virus (VZV) (see Varicella-Zoster Virus)

Bacterial Pneumonia

Chlamydia Pneumoniae (see Chlamydia Pneumoniae)
Inhalational Anthrax (see Bacillus Anthracis)
Legionellosis (see Legionellosis)
Leptospirosis (see Leptospirosis)
Mycoplasma Pneumoniae (see Mycoplasma Pneumoniae)
Pseudomonas Aeruginosa (see Pseudomonas Aeruginosa)
Q Fever (see Q Fever)
Staphylococcus Aureus (see Staphylococcus Aureus)
Streptococcus Anginosus Group (see Streptococcus Anginosus Group)
Streptococcus Mitis Group (see Streptococcus Mitis Group)
Streptococcus Pneumoniae (Pneumococcus) (see Streptococcus Pneumoniae)
Streptococcus Pyogenes (see Streptococcus Pyogenes)
Tuberculosis (see Tuberculosis)
Tularemia (Pneumonic Tularemia) (see Tularemia)

Fungal Pneumonia

Coccidioidomycosis (see Coccidioidomycosis)
Invasive Pulmonary Aspergillosis (see Invasive Aspergillosis)
Pneumocystis Jirovecii (see Pneumocystis Jirovecii)

Parasitic Pneumonia

Malaria (see Malaria)

Aspiration

Aspiration Pneumonia (and Aspiration Pneumonitis) (see Aspiration Pneumonia)
Barium Aspiration (see Barium)
Gastrografin Aspiration (see Gastrografin)
Hydrocarbon Aspiration Pneumonitis (see Hydrocarbons)
Near Drowning (see Near Drowning)
Talcum Powder Aspiration (see Talc)

Dermatologic Disorder

Drug Rash with Eosinophilia and Systemic Symptoms (DRESS) (see Drug Rash with Eosinophilia and Systemic Symptoms)
- Epidemiology (from Systematic Review) (Biomed Res Int, 2019) [MEDLINE]
  - Dyspnea Occurs in 81% of Cases (see Dyspnea)
  - Interstitial Infiltrates/Interstitial Pneumonia Occur in 50% of Cases (see Interstitial Lung Disease)
  - Acute Respiratory Distress Syndrome (ARDS) Occurs in 31% of Cases
  - Cough Occurs in 19% of Cases (see Cough)
Stevens-Johnson Syndrome (SJS) and Toxic Epidermal Necrolysis (TEN) (see Stevens-Johnson Syndrome and Toxic Epidermal Necrolysis)
- Epidemiology
  - Respiratory Complications (Including Sloughing of the Bronchial Epithelium, Pneumonia, Atelectasis, and Acute Respiratory Distress Syndrome) are Common During the Acute Phase of Stevens-Johnson Syndrome (SJS) and Toxic Epidermal Necrolysis (TEN)
  - Approximately 25% of Patients with Pulmonary Involvement Develop Acute Respiratory Failure Requiring Mechanical Ventilation (Crit Care Med, 2014) [MEDLINE]

Trauma/Surgery

Burns (see Burns)
Blast Injury
- Explosion
- Lightning
Fat Embolism (see Fat Embolism)
Head Trauma/Traumatic Brain Injury (TBI) (see Traumatic Brain Injury)
Pulmonary Contusion (see Pulmonary Contusion)
Surgery
- Systematic Review/Meta-Analysis of Morbidity/Mortality in Post-Operative Acute Lung Injury (Lancet Respir Med, 2014) [MEDLINE]
  - Incidence of Acute Lung Injury was Similar Following Both Thoracic and Abdominal Surgery
  - Risk Factors for Post-Operative Acute Lung Injury
    - Higher American Society of Anesthesiology (ASA) Score
    - Higher Prevalence of Pre-Existing Sepsis or Pneumonia
    - Older Age
    - Receipt of Blood Transfusions
    - Receipt of High Tidal Volume Ventilation and/or Low PEEP During Surgery
  - Post-Operative Acute Lung Injury Increased ICU Length of Stay and Hospital Length of Stay
  - Overall Attributable Mortality Rate for Post-Operative Acute Lung Injury: 19%
    - Attributable Mortality Rate for Post-Operative Acute Lung Injury Following Thoracic Surgery: 26.5%
    - Attributable Mortality Rate for Post-Operative Acute Lung Injury Following Abdominal Surgery: 12.2%
  - Risk of In-Hospital Mortality was Independent of the Ventilation Strategy
Other Trauma

Mechanical Pulmonary Edema

Upper Airway Obstruction (see Mechanical Pulmonary Edema and Obstructive Lung Disease)
Overdistention Pulmonary Edema (see Mechanical Pulmonary Edema)
Post-Pneumonectomy Pulmonary Edema (see Mechanical Pulmonary Edema)
Re-Expansion Pulmonary Edema (see Mechanical Pulmonary Edema)

Hemodynamic Disturbance

Anaphylaxis (see Anaphylaxis)
Cardiogenic Shock (see Cardiogenic Shock)
Hemorrhagic Shock (see Hemorrhagic Shock)
Hypovolemic Shock (see Hypovolemic Shock)
Neurogenic Shock (see Neurogenic Shock)
Shock of Any Etiology

Hematologic Disorder

Acute Granulocytic Febrile Transfusion Reaction (see Acute Granulocytic Febrile Transfusion Reaction)
Acute Hemolytic Transfusion Reaction (see Acute Hemolytic Transfusion Reaction)
Acute Promyelocytic Leukemia (APML) (see Acute Promyelocytic Leukemia)
Cardiopulmonary Bypass (see Cardiopulmonary Bypass)
Disseminated Intravascular Coagulation (DIC) (see Disseminated Intravascular Coagulation)
Hemolysis/Elevated Liver Functions/Low Platelet (HELLP) Syndrome (see HELLP Syndrome)
Hemophagocytic Lymphohistiocytosis (HLH) (see Hemophagocytic Lymphohistiocytosis)
- Epidemiology
  - Pulmonary Involvement Has Been Reported in 42% of Adult Cases of Hemophagocytic Lymphohistiocytosis (Lancet, 2014) [MEDLINE]
Leukostasis (Hyperleukocytic Syndrome) (see Leukostasis)
Massive Transfusion
Rh Incompatibility (see Rh Incompatibility)
Transfusion-Associated Acute Lung Injury (TRALI) (see Transfusion-Associated Acute Lung Injury)

Neurogenic Pulmonary Edema (see Neurogenic Pulmonary Edema)

Grand Mal Seizure (see Seizures)
Head Trauma/Traumatic Brain Injury (TBI) (see Traumatic Brain Injury)
Intracerebral Hemorrhage (ICH) (see Intracerebral Hemorrhage)
Subarachnoid Hemorrhage (SAH) (see Subarachnoid Hemorrhage)

Rheumatologic Disease

Adult-Onset Still’s Disease (see Adult-Onset Still’s Disease)
Mixed Connective Tissue Disease (MCTD) (see Mixed Connective Tissue Disease)
Polydermatomyositis (see Polydermatomyositis)
Rheumatoid Arthritis (RA) (see Rheumatoid Arthritis)
Scleroderma (see Scleroderma)
Systemic Lupus Erythematosus (SLE) (see Systemic Lupus Erythematosus)

Lung Transplant Rejection/Dysfunction (see Lung Transplant Rejection)

Acute Lung Transplant Rejection (Acute Cellular Lung Transplant Rejection) (see Acute Lung Transplant Rejection)
- Epidemiology
  - ARDS May Occur in Severe Cases
Hyperacute Lung Transplant Rejection (see Hyperacute Lung Transplant Rejection)
Primary Lung Graft Dysfunction (see Primary Lung Graft Dysfunction)

Drug

Alkylating Agents
- Nitrogen Mustards
  - Cyclophosphamide (Cytoxan) (see Cyclophosphamide)
- Nitrosoureas
  - Carmustine (BCNU) (see Carmustine)
  - Lomustine (CCNU) (see Lomustine)
  - Streptozotocin (see Streptozotocin)
- Alkyl Sulfonates
  - Busulfan (see Busulfan)
Aminoglutethimide (Cytadren) (see Aminoglutethimide)
Amiodarone (Cordarone) (see Amiodarone)
Amphotericin (see Amphotericin)
Anti-Tumor Necrosis Factor-α (Anti-TNFα) Therapy (see Anti-Tumor Necrosis Factor-α Therapy)
- Rituximab (Rituxan) (see Rituximab)
Bacillus Calmette-Guerin (BCG) (see Bacillus Calmette-Guerin)
Barbiturate Intoxication (see Barbiturates)
Bleomycin (see Bleomycin)
Bortezomib (Velcade) (see Bortezomib)
Carbamazepine (Tegretol) (see Carbamazepine)
Cetuximab (Erbitux) (see Cetuximab
Cocaine (see Cocaine)
Colchicine (see Colchicine)
Cytokine Release Syndrome (see Cytokine Release Syndrome): occurs with the administration of specific monoclonal antibodies
- Alemtuzumab (Campath) (see Alemtuzumab)
- Anti-Thymocyte Globulin (ATG) (see Anti-Thymocyte Globulin)
- Lenalidomide (Revlimid) (see Lenalidomide)
- Muromonab-CD3 (Orthoclone OKT3) (see Muromonab-CD3)
- Oxaliplatin (Eloxatin) (see Oxaliplatin)
- Rituximab (Rituxan) (see Rituximab)
Dextran (see Dextran): when used intrauterine for hysteroscopy
Docetaxel (Taxotere) (see Docetaxel)
Ethchlorvynol (see Ethchlorvynol)
Etoposide (VP-16, Vepesid, Toposar, Etopophos) (see Etoposide)
Flecainide (see Flecainide)
Gefitinib (Iressa) (see Gefitinib)
Hydrochlorothiazide (HCTZ) (see Hydrochlorothiazide)
Interferon Gamma-1b (Actimmune) (see Interferon Gamma-1b)
Interleukin-2 (IL-2) (see Interleukin-2)
Leflunomide (Arava) (see Leflunomide)
Mercaptopurine (see Mercaptopurine)
Methotrexate (see Methotrexate)
Mitomycin C (see Mitomycin)
Nicardipine (Cardene) (see Nicardipine)
Nitrofurantoin (see Nitrofurantoin)
Nonsteroidal Anti-Inflammatory Drug (NSAID) Intoxication (see Nonsteroidal Anti-Inflammatory Drug)
Opiates and Related Agents (see Opiates)
- Heroin (see Heroin)
- Methadone (see Methadone)
- Naloxone (Narcan) (see Naloxone)
- Propoxyphene (Darvon) (see Propoxyphene)
Oxygen Toxicity (see Oxygen)
Pranlukast (see Pranlukast)
Programmed Cell Death Protein 1 (PD-1) Checkpoint Inhibitors (see Programmed Cell Death Protein 1 Checkpoint Inhibitors)
- Nivolumab (Opdivo) (see Nivolumab)
- Pembrolizumab (Keytruda) (see Pembrolizumab)
Protamine (see Protamine)
Pyrimidine Analogues
- 5-Fluorouracil (5-FU) (see 5-Fluorouracil)
- Cytarabine (ARA-C) (see Cytarabine)
- Gemcitabine (Gemzar) (see Gemcitabine)
Radiographic Contrast (see Radiographic Contrast)
Ruxolitinib (Jakafi) Withdrawal Syndrome (see Ruxolitinib)
- Epidemiology: occurs 1 day-3 wks after drug withdrawal
Salicylate Intoxication (see Salicylates)
Simvastatin (Zocor) (see Simvastatin)
Sirolimus (Rapamune) (see Sirolimus)
Ticlopidine (Ticlid) (see Ticlopidine)
Tocolytic-Induced Pulmonary Edema (see Tocolytic-Induced Pulmonary Edema)
Topotecan (Hycamtin) (see Topotecan)
Tretinoin (All-Trans Retinoic Acid, ATRA) (see Tretinoin)
Vinblastine (see Vinblastine)

Toxin

Acetic Acid Inhalation (see Acetic Acid)
- Inhalational Exposure
Acetic Anhydride Inhalation (see Acetic Anhydride)
- Inhalational Exposure
Acrolein Inhalation (see Acrolein)
- Inhalational Exposure
Acute Beryllium Exposure (see Beryllium)
- Inhalational Exposure
Amitrole Inhalation (see Amitrole)
- Inhalational Exposure
Ammonia Inhalation (see Ammonia)
- Inhalational Exposure
Bromine/Methyl Bromide Inhalation (see Bromine-Methyl Bromide)
- Inhalational Exposures
  - Bromine Liquid (Readily Vaporizes): used in chemical synthesis and water purification
  - Methyl Bromide Gas (Bromomethane): used as industrial fumigant
Carboxyhemoglobinemia (see Carboxyhemoglobinemia)
- Inhalational Exposure
Chlorine Inhalation (see Chlorine)
- Inhalational Exposure
Chloropicrin Gas Inhalation (see Chloropicrin Gas)
- Inhalational Exposures
  - Chemical Manufacturing
  - Fumigant
  - World War I Wartime Exposure
Chromic Acid Inhalation (see Chromic Acid)
- Inhalational Exposures: used in electroplating
Contaminated Rapeseed Oil (see Contaminated Rapeseed Oil)
Copper Dust/Fume Inhalation (see Copper)
- Inhalational Exposure
Cyanide Intoxication (see Cyanide)
- Fire/Smoke Inhalation (see Smoke Inhalation)
  - Smoke Inhalation is the Most Common Etiology of Cyanide Intoxication in Industrialized Countries
- Industrial Exposure (to Cyanide Salts or Nitriles)
  - Dermal
  - Inhalational
  - Ingestion
- Medical Administration
  - Nitroprusside (Nipride) (see Nitroprusside)
- Dietary Ingestion of Amygdalin (see Amygdalin)
  - Contained in Rosaceae Family Fruit/Nuts, Bamboo Shoots, Cassava Root, Flaxseed, and Soy
- Other
  - Illicit Synthesis of Phencyclidine
  - Terrorist Attack
  - Tobacco Abuse (see Tobacco)
Diazomethane Inhalation (see Diazomethane)
- Inhalational Exposure
Diborane Gas Inhalation (see Diborane Gas)
- Inhalational Exposure During Microelectronics Manufacturing
Dinitrogen Tetroxide Inhalation (see Dinitrogen Tetroxide)
- Inhalational Exposure to Rocket Propellant
Ethylene Oxide Gas Inhalation (see Ethylene Oxide Gas)
- Inhalational Exposure During Medical Disinfection and Sterilization
Formic Acid Inhalation (see Formic Acid)
- Inhalational (Aerosol, Vapor) Exposures
  - Leather Tanning
  - Limescale Remover
  - Rubber Manufacturing
  - Textile Industry
  - Toilet Bowl Cleaner
  - Treatment of Livestock Feed: due to to its antibacterial properties
Glyphosate Ingestion (see Glyphosate
- Ingestion Exposure to Herbicide (Roundup, etc)
Heavy Metal Fume Inhalation
- Cadmium Fume Inhalation (see Cadmium)
- Mercury Fume Inhalation (see Mercury)
- Nickel Carbonyl Fume Inhalation (see Nickel Carbonyl)
- Vanadium Fume Inhalation (see Vanadium)
Hydrocarbons (see Hydrocarbons)
- Ingestion/Aspiration Exposure
Hydrofluoric Acid Inhalation (see Hydrofluoric Acid)
- Inhalational Exposure
Hydrogen Sulfide Gas Inhalation (see Hydrogen Sulfide Gas)
- Inhalational Exposure
Isopropanol Intoxication (see Isopropanol)
Lycoperdonosis (see Lycoperdonosis)
- Inhalational Exposure to Puffball Mushroom (Lycoperdon) Spore, Resulting in Allergic Bronchioloalveolitis
Methamphetamine Intoxication (see Methamphetamine)
Methyl Isocyanate Inhalation (see Methyl Isocyanate)
- Inhalational Exposure
Methyl Isothiocyanate Inhalation (see Methyl Isothiocyanate)
- Inhalational Exposure
Nickel Carbonyl Inhalation (see Nickel Carbonyl)
- Inhalational Exposure
Nitric Acid Inhalation (see Nitric Acid)
- Inhalational Exposure
Nitrogen Dioxide Inhalation (see Nitrogen Dioxide)
- Inhalational Exposure
Nitrogen Mustard Gas Inhalation (see Nitrogen Mustard Gas)
- Inhalational Exposure
Osmium Tetroxide Inhalation (see Osmium Tetroxide)
- Inhalational Exposure
Ozone Inhalation (see Ozone)
- Inhalational Exposure (Welding/Water Treatment/Pulp Paper Bleaching)
Palytoxin (see Palytoxin)
- Epidemiology
  - Palytoxin Rarely is Associated with ARDS
- Inhalational Exposure to Microalgae (Ostreopsis Ovate, Ostreopsis Siamensis), Corals, and Sea Anemones
Paraquat Intoxication (see Paraquat)
- Ingestion Exposure
Phosgene Gas Inhalation (see Phosgene Gas)
- Inhalational Exposure
Phosphine Gas Inhalation (see Phosphine Gas)
- Inhalational Exposure
Polytetrafluoroethylene (PTFE, Teflon) Inhalation (see Polytetrafluoroethylene)
- Inhalational Exposure
Rattlesnake Bite (see Rattlesnake Bite)
Smoke Inhalation (see Smoke Inhalation)
- Inhalational Exposure to Fire (Especially in an Enclosed Space)
Sodium Azide Inhalation (see Sodium Azide)
- Inhalational Exposure (Automobile Airbag Deployment)
Sulfur Dioxide Inhalation (see Sulfur Dioxide
- Inhalational Exposure
Sulfuric Acid Inhalation (see Sulfuric Acid)
- Inhalational Exposure
Sulfur Mustard Gas Inhalation (see Sulfur Mustard Gas)
- Inhalational Exposure
Tear Gas Inhalation (see Tear Gas)
- Inhalational Exposure to Tear Gas Used by Police/Military for Crowd Control
White Phosphorus Inhalation (see White Phosphorus)
- Inhalational Exposure to Firework/Incendiary Explosion
Zinc Chloride Gas Inhalation (see Zinc Chloride Gas)
- Inhalational Exposure to Smoke Bomb

Other

Acute Exacerbation of Idiopathic Pulmonary Fibrosis (IPF) (see Idiopathic Pulmonary Fibrosis)
Acute Interstitial Pneumonia (AIP) (see Acute Interstitial Pneumonia)
Acute Pancreatitis (see Acute Pancreatitis)
Air Embolism (see Air Embolism)
Amniotic Fluid Embolism (see Amniotic Fluid Embolism)
Diabetic Ketoacidosis (DKA) (see Diabetic Ketoacidosis and Hyperosmolar Hyperglycemic State)
Esophageal Variceal Sclerotherapy (see Esophageal Varices)
- Epidemiology
  - Acute Respiratory Distress Syndrome (ARDS) Occurs in <1% of Cases of Esophageal Variceal Sclerotherapy
High-Altitude Pulmonary Edema (HAPE) (see High-Altitude Pulmonary Edema)
Hyponatremia (see Hyponatremia)
- Epidemiology
  - Noncardiogenic Pulmonary Edema Has Been Reported When the Serum Sodium Falls to <115-120 mEq/L (Ann Intern Med, 2000) [MEDLINE]
Preeclampsia/Eclampsia (see Preeclampsia and Eclampsia)
- Epidemiology
  - Acute Respiratory Distress Syndrome Occurs in 3% of Patients with Preeclampsia
Radiation Pneumonitis and Fibrosis (see Radiation Pneumonitis and Fibrosis)

References

General

Acute respiratory distress in adults. Lancet. 1967 Aug 12;2(7511):319-23. doi: 10.1016/s0140-6736(67)90168-7 [MEDLINE]
The American-European Consensus Conference on ARDS. Definitions, mechanisms, relevant outcomes, and clinical trial coordination. Am J Respir Crit Care Med 1994;149:818–824 [MEDLINE]
The acute respiratory distress syndrome. N Engl J Med 1995; 332:27-37
Clinical risk factors for pulmonary barotrauma: a multivariate analysis. Am J Respir Crit Care Med 1995; 152:1235-1240
Pathogenesis and treatment of the adult respiratory distress syndrome. Arch Intern Med 1996; 156:29-38
The relation of pneumothorax and other air leaks to mortality in the acute respiratory distress syndrome. N Engl J Med 1998; 338:341-346
The acute respiratory distress syndrome. N Engl J Med. 2000 May 4;342(18):1334-49 [MEDLINE]
What has computed tomography taught us about the acute respiratory distress syndrome? Am J Respir Crit Care Med. 2001 Nov 1;164(9):1701-11 [MEDLINE]
Hypocapnia. NEJM 2002: 347:43-53 [MEDLINE]
Pressure-volume curves and compliance in acute lung injury: evidence of recruitment above the lower inflection point. Am J Respir Crit Care Med 1999; 159:1172-1178
Consensus conference on mechanical ventilation. Intensive Care Med 1994; 20:64-79, 150-162
The American-European consensus conference on ARDS. Am J Respir Crit Care Med 1994;149:818-824
Patient-ventilator interactions. Clin Chest Med 1996; 17:423-438.
Patient-ventilator interaction. Br J Anaesthes 2003; 19:106-119.
Patient ventilator interaction. Am J Respir Crit Care Med 2001; 163:1059-1063.
Influence of cardiac output on intrapulmonary shunt. J Appl Physiol 1979; 46:315-321
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Current definitions of acute lung injury and the acute respiratory distress syndrome do not reflect their true severity and outcome. Intensive Care Med. 1999;25(9):930-935 [MEDLINE]
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Severe Hypoxemic Respiratory Failure, Part 1—Ventilatory Strategies. Chest 2010; 137(5):1203–1216 [MEDLINE]
Severe hypoxemic respiratory failure: part 2-Nonventilatory strategies. Chest. 2010 Jun;137(6):1437-48 [MEDLINE]
Acute respiratory distress syndrome: the Berlin Definition. JAMA. 2012 Jun 20;307(23):2526-33 [MEDLINE]
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The association between physiologic dead-space fraction and mortality in subjects with ARDS enrolled in a prospective multi-center clinical trial. Respir Care. 2014;59:1611–1618 [MEDLINE]
Driving pressure and survival in the acute respiratory distress syndrome. N Engl J Med 2015;372:747-755 [MEDLINE]
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An Update on Management of Adult Patients with Acute Respiratory Distress Syndrome: An Official American Thoracic Society Clinical Practice Guideline. Am J Respir Crit Care Med. 2023 Nov 30. doi: 10.1164/rccm.202311-2011ST [MEDLINE]

Epidemiology

Epidemiology of acute lung injury. Curr Opin Crit Care. 2005;11(1):43 [MEDLINE]
Incidence and outcomes of acute lung injury. N Engl J Med. 2005;353(16):1685 [MEDLINE]
LUNG SAFE Study. Epidemiology, Patterns of Care, and Mortality for Patients With Acute Respiratory Distress Syndrome in Intensive Care Units in 50 Countries. JAMA. 2016 Feb 23;315(8):788-800. doi: 10.1001/jama.2016.0291 [MEDLINE]
Preadmission Oral Corticosteroids Are Associated With Reduced Risk of Acute Respiratory Distress Syndrome in Critically Ill Adults With Sepsis. Crit Care Med. 2017 May;45(5):774-780. doi: 10.1097/CCM.0000000000002286 [MEDLINE]
Older Adult Patients Are at Lower Risk of ARDS Compared to Younger Patients at Risk: Secondary Analysis of a Multicenter Cohort Study. J Intensive Care Med. 2019 May 8:885066619848357. doi: 10.1177/0885066619848357 [MEDLINE]
The Cost of ARDS: A Systematic Review. Chest. 2021 Aug 31;S0012-3692(21)03829-0. doi: 10.1016/j.chest.2021.08.057 [MEDLINE]
Association of adverse respiratory events with sodium-glucose cotransporter 2 inhibitors versus dipeptidyl peptidase 4 inhibitors among patients with type 2 diabetes in South Korea: a nationwide cohort study. BMC Med. 2023 Feb 10;21(1):47. doi: 10.1186/s12916-023-02765-2 [MEDLINE]

Etiology

Infection

Chronic alcohol abuse is associated with an increased incidence of acute respiratory distress syndrome and severity of multiple organ dysfunction in patients with septic shock. Crit Care Med. 2003;31(3):869 [MEDLINE]
Risk factors for the development of acute lung injury in patients with septic shock: an observational cohort study. Crit Care Med. 2008;36(5):1518 [MEDLINE]
Early risk factors and the role of fluid administration in developing acute respiratory distress syndrome in septic patients. Ann Intensive Care. 2017;7(1):11. Epub 2017 Jan 23 [MEDLINE]

Hematologic Disorder

Adult haemophagocytic syndrome. Lancet. 2014;383(9927):1503 [MEDLINE]

Other

Hyponatremia, cerebral edema, and noncardiogenic pulmonary edema in marathon runners. Ann Intern Med. 2000 May 2;132(9):711-4. doi: 10.7326/0003-4819-132-9-200005020-00005 [MEDLINE]