Diagnosis and Management of Acute Respiratory Distress Syndrome in a Time of COVID-19
Acute respiratory distress syndrome (ARDS) remains a serious illness with significant morbidity and mortality, characterized by hypoxemic respiratory failure most commonly due to pneumonia, sepsis, and aspiration. Early and accurate diagnosis of ARDS depends upon clinical suspicion and chest imaging...
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| Format: | Article |
| Language: | English |
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MDPI AG
2020-12-01
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| Series: | Diagnostics |
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| Online Access: | https://www.mdpi.com/2075-4418/10/12/1053 |
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| author | Shayan Kassirian Ravi Taneja Sanjay Mehta |
| author_facet | Shayan Kassirian Ravi Taneja Sanjay Mehta |
| author_sort | Shayan Kassirian |
| collection | DOAJ |
| description | Acute respiratory distress syndrome (ARDS) remains a serious illness with significant morbidity and mortality, characterized by hypoxemic respiratory failure most commonly due to pneumonia, sepsis, and aspiration. Early and accurate diagnosis of ARDS depends upon clinical suspicion and chest imaging. Coronavirus disease 2019 (COVID-19) is an important novel cause of ARDS with a distinct time course, imaging and laboratory features from the time of SARS-CoV-2 infection to hypoxemic respiratory failure, which may allow diagnosis and management prior to or at earlier stages of ARDS. Treatment of ARDS remains largely supportive, and consists of incremental respiratory support (high flow nasal oxygen, non-invasive respiratory support, and invasive mechanical ventilation), and avoidance of iatrogenic complications, all of which improve clinical outcomes. COVID-19-associated ARDS is largely similar to other causes of ARDS with respect to pathology and respiratory physiology, and as such, COVID-19 patients with hypoxemic respiratory failure should typically be managed as other patients with ARDS. Non-invasive respiratory support may be beneficial in avoiding intubation in COVID-19 respiratory failure including mild ARDS, especially under conditions of resource constraints or to avoid overwhelming critical care resources. Compared to other causes of ARDS, medical therapies may improve outcomes in COVID-19-associated ARDS, such as dexamethasone and remdesivir. Future improved clinical outcomes in ARDS of all causes depends upon individual patient physiological and biological endotyping in order to improve accuracy and timeliness of diagnosis as well as optimal targeting of future therapies in the right patient at the right time in their disease. |
| first_indexed | 2024-03-10T14:17:39Z |
| format | Article |
| id | doaj.art-9d881ec7002042a6be3a846dc71ad5a0 |
| institution | Directory Open Access Journal |
| issn | 2075-4418 |
| language | English |
| last_indexed | 2024-03-10T14:17:39Z |
| publishDate | 2020-12-01 |
| publisher | MDPI AG |
| record_format | Article |
| series | Diagnostics |
| spelling | doaj.art-9d881ec7002042a6be3a846dc71ad5a02023-11-20T23:40:37ZengMDPI AGDiagnostics2075-44182020-12-011012105310.3390/diagnostics10121053Diagnosis and Management of Acute Respiratory Distress Syndrome in a Time of COVID-19Shayan Kassirian0Ravi Taneja1Sanjay Mehta2Division of Critical Care Medicine, Centre for Critical Illness Research, Lawson Health Research Institute, London Health Sciences Center, London, ON N6A 5W9, CanadaDivision of Critical Care Medicine, Centre for Critical Illness Research, Lawson Health Research Institute, London Health Sciences Center, London, ON N6A 5W9, CanadaDepartment of Medicine, Schulich Faculty of Medicine and Dentistry, Western University, London, ON N6A 5W9, CanadaAcute respiratory distress syndrome (ARDS) remains a serious illness with significant morbidity and mortality, characterized by hypoxemic respiratory failure most commonly due to pneumonia, sepsis, and aspiration. Early and accurate diagnosis of ARDS depends upon clinical suspicion and chest imaging. Coronavirus disease 2019 (COVID-19) is an important novel cause of ARDS with a distinct time course, imaging and laboratory features from the time of SARS-CoV-2 infection to hypoxemic respiratory failure, which may allow diagnosis and management prior to or at earlier stages of ARDS. Treatment of ARDS remains largely supportive, and consists of incremental respiratory support (high flow nasal oxygen, non-invasive respiratory support, and invasive mechanical ventilation), and avoidance of iatrogenic complications, all of which improve clinical outcomes. COVID-19-associated ARDS is largely similar to other causes of ARDS with respect to pathology and respiratory physiology, and as such, COVID-19 patients with hypoxemic respiratory failure should typically be managed as other patients with ARDS. Non-invasive respiratory support may be beneficial in avoiding intubation in COVID-19 respiratory failure including mild ARDS, especially under conditions of resource constraints or to avoid overwhelming critical care resources. Compared to other causes of ARDS, medical therapies may improve outcomes in COVID-19-associated ARDS, such as dexamethasone and remdesivir. Future improved clinical outcomes in ARDS of all causes depends upon individual patient physiological and biological endotyping in order to improve accuracy and timeliness of diagnosis as well as optimal targeting of future therapies in the right patient at the right time in their disease.https://www.mdpi.com/2075-4418/10/12/1053acute respiratory distress syndrome (ARDS)COVID-19SARS-CoV-2high flow nasal oxygennon-invasive ventilationmechanical ventilation |
| spellingShingle | Shayan Kassirian Ravi Taneja Sanjay Mehta Diagnosis and Management of Acute Respiratory Distress Syndrome in a Time of COVID-19 Diagnostics acute respiratory distress syndrome (ARDS) COVID-19 SARS-CoV-2 high flow nasal oxygen non-invasive ventilation mechanical ventilation |
| title | Diagnosis and Management of Acute Respiratory Distress Syndrome in a Time of COVID-19 |
| title_full | Diagnosis and Management of Acute Respiratory Distress Syndrome in a Time of COVID-19 |
| title_fullStr | Diagnosis and Management of Acute Respiratory Distress Syndrome in a Time of COVID-19 |
| title_full_unstemmed | Diagnosis and Management of Acute Respiratory Distress Syndrome in a Time of COVID-19 |
| title_short | Diagnosis and Management of Acute Respiratory Distress Syndrome in a Time of COVID-19 |
| title_sort | diagnosis and management of acute respiratory distress syndrome in a time of covid 19 |
| topic | acute respiratory distress syndrome (ARDS) COVID-19 SARS-CoV-2 high flow nasal oxygen non-invasive ventilation mechanical ventilation |
| url | https://www.mdpi.com/2075-4418/10/12/1053 |
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