Acute respiratory distress syndrome

Nat Rev Dis Primers. 2019 Mar 14;5(1):18. doi: 10.1038/s41572-019-0069-0.


The acute respiratory distress syndrome (ARDS) is a common cause of respiratory failure in critically ill patients and is defined by the acute onset of noncardiogenic pulmonary oedema, hypoxaemia and the need for mechanical ventilation. ARDS occurs most often in the setting of pneumonia, sepsis, aspiration of gastric contents or severe trauma and is present in ~10% of all patients in intensive care units worldwide. Despite some improvements, mortality remains high at 30-40% in most studies. Pathological specimens from patients with ARDS frequently reveal diffuse alveolar damage, and laboratory studies have demonstrated both alveolar epithelial and lung endothelial injury, resulting in accumulation of protein-rich inflammatory oedematous fluid in the alveolar space. Diagnosis is based on consensus syndromic criteria, with modifications for under-resourced settings and in paediatric patients. Treatment focuses on lung-protective ventilation; no specific pharmacotherapies have been identified. Long-term outcomes of patients with ARDS are increasingly recognized as important research targets, as many patients survive ARDS only to have ongoing functional and/or psychological sequelae. Future directions include efforts to facilitate earlier recognition of ARDS, identifying responsive subsets of patients and ongoing efforts to understand fundamental mechanisms of lung injury to design specific treatments.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't
  • Review

MeSH terms

  • Angiopoietin-2 / analysis
  • Antigens, CD / physiology
  • Biomarkers / analysis
  • Cadherins / physiology
  • Carbon Dioxide / analysis
  • Carbon Dioxide / metabolism
  • Glucocorticoids / therapeutic use
  • High-Frequency Ventilation / methods
  • Humans
  • Interleukin-8 / analysis
  • Positive-Pressure Respiration / methods
  • Quality of Life / psychology
  • Radiography / methods
  • Respiration, Artificial / adverse effects
  • Respiration, Artificial / methods
  • Respiratory Distress Syndrome / diagnosis*
  • Respiratory Distress Syndrome / epidemiology
  • Respiratory Distress Syndrome / physiopathology
  • Vasodilator Agents / therapeutic use
  • Ventilator-Induced Lung Injury / complications*
  • Ventilator-Induced Lung Injury / physiopathology
  • von Willebrand Factor / analysis


  • ANGPT2 protein, human
  • Angiopoietin-2
  • Antigens, CD
  • Biomarkers
  • Cadherins
  • Glucocorticoids
  • Interleukin-8
  • Vasodilator Agents
  • cadherin 5
  • von Willebrand Factor
  • Carbon Dioxide