Principles and Management of ARDS

Acute respiratory distress syndrome (ARDS) was described for the first time more than 40 years ago. Since then, several progresses have been made in its definition, management, and in the understanding of the underlying pathophysiology. Despite ARDS is a syndrome of different entities and probably different inflammatory and biomechanical phenotypes, ARDS patients share some common features, like the need of respiratory support and the increased risk of ventilation-induced lung injury (VILI). Mechanical ventilation is an essential tool in supporting gas exchange but can amplify lung damage and increase lung inflammation. Finally, ARDS patients may be exposed to a higher risk of complications, such as delirium and ICU-acquired weakness. In this chapter, we will explore the current knowledge on ARDS definition, classification, pathophysiology, possible therapies, and complications, focusing on open questions being explored in the last years. Moreover, we will discuss the role of adjuvant therapies, such as pharmacological therapy and VV-ECMO, and their current indication.