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Acute respiratory distress syndrome
What's new
Updated 2024 SCCM guidelines on the use of corticosteroids in acute respiratory distress syndrome .
Background
Overview
Definition
ARDS is an acute inflammatory disease of the lungs that develops secondary to pulmonary or extrapulmonary damage to the alveolar-capillary membrane, leading to interstitial and alveolar edema. Clinically, ARDS is characterized by acute hypoxemic respiratory failure, decreased lung compliance, and bilateral radiographic infiltrates in the absence of cardiogenic pulmonary edema.
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Pathophysiology
An acute injury to the lungs (direct or indirect) is the most common cause of ARDS, with pneumonia, aspiration of gastric contents, and sepsis accounting for > 85% of all cases.
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Epidemiology
In the US, the incidence of ARDS is estimated at 64.2-78.9 cases per 100,000 person-years.
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Disease course
Classically, an initial exudative phase with interstitial and alveolar edema is followed by a proliferative phase, which may further progress to a fibrotic phase. The latter is associated with collagen deposition, along with interstitial and alveolar fibrosis, causing decreased lung compliance, respiratory dysfunction, multisystem organ failure, and death.
2
Prognosis and risk of recurrence
ARDS is associated with an in-hospital mortality of 27%, 32%, and 45% for mild, moderate, and severe disease, respectively.
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Guidelines
Key sources
The following summarized guidelines for the evaluation and management of acute respiratory distress syndrome are prepared by our editorial team based on guidelines from the Society of Critical Care Medicine (SCCM 2025,2024,2016), the American Thoracic Society (ATS 2024), the European Society of Intensive Care Medicine (ESICM 2024,2023), the International Collaboration for Transfusion Medicine Guidelines (ICTMG 2024), the Japanese Society of ...
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