2021 Acute Respiratory Distress Syndrome Update, With Coronavirus Disease 2019 Focus

J Cardiothorac Vasc Anesth. 2022 Apr;36(4):1188-1195. doi: 10.1053/j.jvca.2021.02.053. Epub 2021 Feb 27.


Acute respiratory distress syndrome (ARDS) is a heterogeneous lung disease responsible for significant morbidity and mortality among critically ill patients, including those infected with severe acute respiratory syndrome coronavirus 2, the virus responsible for coronavirus disease 2019. Despite recent advances in pathophysiology, diagnostics, and therapeutics, ARDS is dangerously underdiagnosed, and supportive lung protective ventilation and prone positioning remain the mainstay interventions. Rescue therapies, including neuromuscular blockade and venovenous extracorporeal membrane oxygenation, remain a key component of clinical practice, although benefits are unclear. Even though coronavirus disease 2019 ARDS has some distinguishing features from traditional ARDS, including delayed onset, hyperinflammatory response, and pulmonary microthrombi, it clinically is similar to traditional ARDS and should be treated with established supportive therapies.

Keywords: COVID-19; acute respiratory distress syndrome; coronavirus disease 2019; extracorporeal membrane oxygenation; mechanical ventilation; neuromuscular blocking agents; nitric oxide; positive end-expiratory pressure; prone position; ventilator-induced lung injury.

Publication types

  • Review

MeSH terms

  • COVID-19*
  • Extracorporeal Membrane Oxygenation*
  • Humans
  • Respiration, Artificial
  • Respiratory Distress Syndrome* / diagnosis
  • Respiratory Distress Syndrome* / etiology
  • Respiratory Distress Syndrome* / therapy
  • SARS-CoV-2