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Severe Acute Respiratory Distress Syndrome

MedGen UID:
1724501
•Concept ID:
C5419624
•
Disease or Syndrome
Synonym: Severe ARDS

Definition

A form of acute respiratory distress syndrome (ARDS) that is marked by severe hypoxemia. Based on the Berlin criteria, onset must occur within one week of a clinical insult or there must be evidence of new or worsening respiratory symptoms. Chest imaging reveals bilateral opacities consistent with pulmonary edema that are not fully explained by effusions, lobar/lung collapse, or nodules. Respiratory failure is not fully explained by heart failure or fluid overload and objective assessment, e.g. echocardiography, is required to exclude hydrostatic edema if no risk factor is present. Additionally, oxygenation as measured by a partial pressure of arterial oxygen (PaO2) to the fraction of inspired oxygen (FIO2) is equivalent to 100 mm Hg or less with positive end-expiratory pressure (PEEP) of at least 5 cm of water (Ranieri VM et al., JAMA. 2012;307(23):2526-2533). Severe ARDS may be associated with cytokine release syndrome. [from NCI]

Term Hierarchy

CClinical test,  RResearch test,  OOMIM,  GGeneReviews,  VClinVar  
  • CROGVSevere Acute Respiratory Distress Syndrome

Professional guidelines

PubMed

Global Initiative for the Diagnosis, Management, and Prevention of Chronic Obstructive Lung Disease. The 2020 GOLD Science Committee Report on COVID-19 and Chronic Obstructive Pulmonary Disease.
Halpin DMG, Criner GJ, Papi A, Singh D, Anzueto A, Martinez FJ, Agusti AA, Vogelmeier CF
Am J Respir Crit Care Med 2021 Jan 1;203(1):24-36. doi: 10.1164/rccm.202009-3533SO. PMID: 33146552Free PMC Article
COVID-19 and the cardiovascular system: implications for risk assessment, diagnosis, and treatment options.
Guzik TJ, Mohiddin SA, Dimarco A, Patel V, Savvatis K, Marelli-Berg FM, Madhur MS, Tomaszewski M, Maffia P, D'Acquisto F, Nicklin SA, Marian AJ, Nosalski R, Murray EC, Guzik B, Berry C, Touyz RM, Kreutz R, Wang DW, Bhella D, Sagliocco O, Crea F, Thomson EC, McInnes IB
Cardiovasc Res 2020 Aug 1;116(10):1666-1687. doi: 10.1093/cvr/cvaa106. PMID: 32352535Free PMC Article
Guidelines for the diagnosis and management of critical illness-related corticosteroid insufficiency (CIRCI) in critically ill patients (Part I): Society of Critical Care Medicine (SCCM) and European Society of Intensive Care Medicine (ESICM) 2017.
Annane D, Pastores SM, Rochwerg B, Arlt W, Balk RA, Beishuizen A, Briegel J, Carcillo J, Christ-Crain M, Cooper MS, Marik PE, Umberto Meduri G, Olsen KM, Rodgers S, Russell JA, Van den Berghe G
Intensive Care Med 2017 Dec;43(12):1751-1763. Epub 2017 Sep 21 doi: 10.1007/s00134-017-4919-5. PMID: 28940011

Recent clinical studies

Etiology

Global Initiative for the Diagnosis, Management, and Prevention of Chronic Obstructive Lung Disease. The 2020 GOLD Science Committee Report on COVID-19 and Chronic Obstructive Pulmonary Disease.
Halpin DMG, Criner GJ, Papi A, Singh D, Anzueto A, Martinez FJ, Agusti AA, Vogelmeier CF
Am J Respir Crit Care Med 2021 Jan 1;203(1):24-36. doi: 10.1164/rccm.202009-3533SO. PMID: 33146552Free PMC Article
Effect of Dexamethasone on Days Alive and Ventilator-Free in Patients With Moderate or Severe Acute Respiratory Distress Syndrome and COVID-19: The CoDEX Randomized Clinical Trial.
Tomazini BM, Maia IS, Cavalcanti AB, Berwanger O, Rosa RG, Veiga VC, Avezum A, Lopes RD, Bueno FR, Silva MVAO, Baldassare FP, Costa ELV, Moura RAB, Honorato MO, Costa AN, Damiani LP, Lisboa T, Kawano-Dourado L, Zampieri FG, Olivato GB, Righy C, Amendola CP, Roepke RML, Freitas DHM, Forte DN, Freitas FGR, Fernandes CCF, Melro LMG, Junior GFS, Morais DC, Zung S, Machado FR, Azevedo LCP; COALITION COVID-19 Brazil III Investigators
JAMA 2020 Oct 6;324(13):1307-1316. doi: 10.1001/jama.2020.17021. PMID: 32876695Free PMC Article
Pulmonary fibrosis and COVID-19: the potential role for antifibrotic therapy.
George PM, Wells AU, Jenkins RG
Lancet Respir Med 2020 Aug;8(8):807-815. Epub 2020 May 15 doi: 10.1016/S2213-2600(20)30225-3. PMID: 32422178Free PMC Article
Extracorporeal Membrane Oxygenation for Severe Acute Respiratory Distress Syndrome.
Combes A, Hajage D, Capellier G, Demoule A, Lavoué S, Guervilly C, Da Silva D, Zafrani L, Tirot P, Veber B, Maury E, Levy B, Cohen Y, Richard C, Kalfon P, Bouadma L, Mehdaoui H, Beduneau G, Lebreton G, Brochard L, Ferguson ND, Fan E, Slutsky AS, Brodie D, Mercat A; EOLIA Trial Group, REVA, and ECMONet
N Engl J Med 2018 May 24;378(21):1965-1975. doi: 10.1056/NEJMoa1800385. PMID: 29791822
Prone positioning in severe acute respiratory distress syndrome.
Guérin C, Reignier J, Richard JC, Beuret P, Gacouin A, Boulain T, Mercier E, Badet M, Mercat A, Baudin O, Clavel M, Chatellier D, Jaber S, Rosselli S, Mancebo J, Sirodot M, Hilbert G, Bengler C, Richecoeur J, Gainnier M, Bayle F, Bourdin G, Leray V, Girard R, Baboi L, Ayzac L; PROSEVA Study Group
N Engl J Med 2013 Jun 6;368(23):2159-68. Epub 2013 May 20 doi: 10.1056/NEJMoa1214103. PMID: 23688302

Diagnosis

Global Initiative for the Diagnosis, Management, and Prevention of Chronic Obstructive Lung Disease. The 2020 GOLD Science Committee Report on COVID-19 and Chronic Obstructive Pulmonary Disease.
Halpin DMG, Criner GJ, Papi A, Singh D, Anzueto A, Martinez FJ, Agusti AA, Vogelmeier CF
Am J Respir Crit Care Med 2021 Jan 1;203(1):24-36. doi: 10.1164/rccm.202009-3533SO. PMID: 33146552Free PMC Article
COVID-19-associated Guillain-Barré syndrome: The early pandemic experience.
Caress JB, Castoro RJ, Simmons Z, Scelsa SN, Lewis RA, Ahlawat A, Narayanaswami P
Muscle Nerve 2020 Oct;62(4):485-491. Epub 2020 Aug 11 doi: 10.1002/mus.27024. PMID: 32678460Free PMC Article
Prevention of pressure ulcers among individuals cared for in the prone position: lessons for the COVID-19 emergency.
Moore Z, Patton D, Avsar P, McEvoy NL, Curley G, Budri A, Nugent L, Walsh S, O'Connor T
J Wound Care 2020 Jun 2;29(6):312-320. doi: 10.12968/jowc.2020.29.6.312. PMID: 32530776
COVID-19 and the cardiovascular system: implications for risk assessment, diagnosis, and treatment options.
Guzik TJ, Mohiddin SA, Dimarco A, Patel V, Savvatis K, Marelli-Berg FM, Madhur MS, Tomaszewski M, Maffia P, D'Acquisto F, Nicklin SA, Marian AJ, Nosalski R, Murray EC, Guzik B, Berry C, Touyz RM, Kreutz R, Wang DW, Bhella D, Sagliocco O, Crea F, Thomson EC, McInnes IB
Cardiovasc Res 2020 Aug 1;116(10):1666-1687. doi: 10.1093/cvr/cvaa106. PMID: 32352535Free PMC Article
Guidelines for the diagnosis and management of critical illness-related corticosteroid insufficiency (CIRCI) in critically ill patients (Part I): Society of Critical Care Medicine (SCCM) and European Society of Intensive Care Medicine (ESICM) 2017.
Annane D, Pastores SM, Rochwerg B, Arlt W, Balk RA, Beishuizen A, Briegel J, Carcillo J, Christ-Crain M, Cooper MS, Marik PE, Umberto Meduri G, Olsen KM, Rodgers S, Russell JA, Van den Berghe G
Intensive Care Med 2017 Dec;43(12):1751-1763. Epub 2017 Sep 21 doi: 10.1007/s00134-017-4919-5. PMID: 28940011

Therapy

Global Initiative for the Diagnosis, Management, and Prevention of Chronic Obstructive Lung Disease. The 2020 GOLD Science Committee Report on COVID-19 and Chronic Obstructive Pulmonary Disease.
Halpin DMG, Criner GJ, Papi A, Singh D, Anzueto A, Martinez FJ, Agusti AA, Vogelmeier CF
Am J Respir Crit Care Med 2021 Jan 1;203(1):24-36. doi: 10.1164/rccm.202009-3533SO. PMID: 33146552Free PMC Article
Effect of Dexamethasone on Days Alive and Ventilator-Free in Patients With Moderate or Severe Acute Respiratory Distress Syndrome and COVID-19: The CoDEX Randomized Clinical Trial.
Tomazini BM, Maia IS, Cavalcanti AB, Berwanger O, Rosa RG, Veiga VC, Avezum A, Lopes RD, Bueno FR, Silva MVAO, Baldassare FP, Costa ELV, Moura RAB, Honorato MO, Costa AN, Damiani LP, Lisboa T, Kawano-Dourado L, Zampieri FG, Olivato GB, Righy C, Amendola CP, Roepke RML, Freitas DHM, Forte DN, Freitas FGR, Fernandes CCF, Melro LMG, Junior GFS, Morais DC, Zung S, Machado FR, Azevedo LCP; COALITION COVID-19 Brazil III Investigators
JAMA 2020 Oct 6;324(13):1307-1316. doi: 10.1001/jama.2020.17021. PMID: 32876695Free PMC Article
Pulmonary fibrosis and COVID-19: the potential role for antifibrotic therapy.
George PM, Wells AU, Jenkins RG
Lancet Respir Med 2020 Aug;8(8):807-815. Epub 2020 May 15 doi: 10.1016/S2213-2600(20)30225-3. PMID: 32422178Free PMC Article
Extracorporeal Membrane Oxygenation for Severe Acute Respiratory Distress Syndrome.
Combes A, Hajage D, Capellier G, Demoule A, Lavoué S, Guervilly C, Da Silva D, Zafrani L, Tirot P, Veber B, Maury E, Levy B, Cohen Y, Richard C, Kalfon P, Bouadma L, Mehdaoui H, Beduneau G, Lebreton G, Brochard L, Ferguson ND, Fan E, Slutsky AS, Brodie D, Mercat A; EOLIA Trial Group, REVA, and ECMONet
N Engl J Med 2018 May 24;378(21):1965-1975. doi: 10.1056/NEJMoa1800385. PMID: 29791822
Prone positioning in severe acute respiratory distress syndrome.
Guérin C, Reignier J, Richard JC, Beuret P, Gacouin A, Boulain T, Mercier E, Badet M, Mercat A, Baudin O, Clavel M, Chatellier D, Jaber S, Rosselli S, Mancebo J, Sirodot M, Hilbert G, Bengler C, Richecoeur J, Gainnier M, Bayle F, Bourdin G, Leray V, Girard R, Baboi L, Ayzac L; PROSEVA Study Group
N Engl J Med 2013 Jun 6;368(23):2159-68. Epub 2013 May 20 doi: 10.1056/NEJMoa1214103. PMID: 23688302

Prognosis

Role of computed tomography in COVID-19.
Pontone G, Scafuri S, Mancini ME, Agalbato C, Guglielmo M, Baggiano A, Muscogiuri G, Fusini L, Andreini D, Mushtaq S, Conte E, Annoni A, Formenti A, Gennari AG, Guaricci AI, Rabbat MR, Pompilio G, Pepi M, Rossi A
J Cardiovasc Comput Tomogr 2021 Jan-Feb;15(1):27-36. Epub 2020 Sep 4 doi: 10.1016/j.jcct.2020.08.013. PMID: 32952101Free PMC Article
COVID-19-associated Guillain-Barré syndrome: The early pandemic experience.
Caress JB, Castoro RJ, Simmons Z, Scelsa SN, Lewis RA, Ahlawat A, Narayanaswami P
Muscle Nerve 2020 Oct;62(4):485-491. Epub 2020 Aug 11 doi: 10.1002/mus.27024. PMID: 32678460Free PMC Article
COVID-19 and the cardiovascular system: implications for risk assessment, diagnosis, and treatment options.
Guzik TJ, Mohiddin SA, Dimarco A, Patel V, Savvatis K, Marelli-Berg FM, Madhur MS, Tomaszewski M, Maffia P, D'Acquisto F, Nicklin SA, Marian AJ, Nosalski R, Murray EC, Guzik B, Berry C, Touyz RM, Kreutz R, Wang DW, Bhella D, Sagliocco O, Crea F, Thomson EC, McInnes IB
Cardiovasc Res 2020 Aug 1;116(10):1666-1687. doi: 10.1093/cvr/cvaa106. PMID: 32352535Free PMC Article
Venovenous extracorporeal membrane oxygenation for acute respiratory distress syndrome: a systematic review and meta-analysis.
Munshi L, Walkey A, Goligher E, Pham T, Uleryk EM, Fan E
Lancet Respir Med 2019 Feb;7(2):163-172. Epub 2019 Jan 11 doi: 10.1016/S2213-2600(18)30452-1. PMID: 30642776
Prone positioning in severe acute respiratory distress syndrome.
Guérin C, Reignier J, Richard JC, Beuret P, Gacouin A, Boulain T, Mercier E, Badet M, Mercat A, Baudin O, Clavel M, Chatellier D, Jaber S, Rosselli S, Mancebo J, Sirodot M, Hilbert G, Bengler C, Richecoeur J, Gainnier M, Bayle F, Bourdin G, Leray V, Girard R, Baboi L, Ayzac L; PROSEVA Study Group
N Engl J Med 2013 Jun 6;368(23):2159-68. Epub 2013 May 20 doi: 10.1056/NEJMoa1214103. PMID: 23688302

Clinical prediction guides

Extracorporeal membrane oxygenation for COVID-19: a systematic review and meta-analysis.
Ramanathan K, Shekar K, Ling RR, Barbaro RP, Wong SN, Tan CS, Rochwerg B, Fernando SM, Takeda S, MacLaren G, Fan E, Brodie D
Crit Care 2021 Jun 14;25(1):211. doi: 10.1186/s13054-021-03634-1. PMID: 34127027Free PMC Article
Effect of Dexamethasone on Days Alive and Ventilator-Free in Patients With Moderate or Severe Acute Respiratory Distress Syndrome and COVID-19: The CoDEX Randomized Clinical Trial.
Tomazini BM, Maia IS, Cavalcanti AB, Berwanger O, Rosa RG, Veiga VC, Avezum A, Lopes RD, Bueno FR, Silva MVAO, Baldassare FP, Costa ELV, Moura RAB, Honorato MO, Costa AN, Damiani LP, Lisboa T, Kawano-Dourado L, Zampieri FG, Olivato GB, Righy C, Amendola CP, Roepke RML, Freitas DHM, Forte DN, Freitas FGR, Fernandes CCF, Melro LMG, Junior GFS, Morais DC, Zung S, Machado FR, Azevedo LCP; COALITION COVID-19 Brazil III Investigators
JAMA 2020 Oct 6;324(13):1307-1316. doi: 10.1001/jama.2020.17021. PMID: 32876695Free PMC Article
Exosomes Derived from Bone Marrow Mesenchymal Stem Cells as Treatment for Severe COVID-19.
Sengupta V, Sengupta S, Lazo A, Woods P, Nolan A, Bremer N
Stem Cells Dev 2020 Jun 15;29(12):747-754. Epub 2020 May 12 doi: 10.1089/scd.2020.0080. PMID: 32380908Free PMC Article
Venovenous extracorporeal membrane oxygenation for acute respiratory distress syndrome: a systematic review and meta-analysis.
Munshi L, Walkey A, Goligher E, Pham T, Uleryk EM, Fan E
Lancet Respir Med 2019 Feb;7(2):163-172. Epub 2019 Jan 11 doi: 10.1016/S2213-2600(18)30452-1. PMID: 30642776
Prone positioning in severe acute respiratory distress syndrome.
Guérin C, Reignier J, Richard JC, Beuret P, Gacouin A, Boulain T, Mercier E, Badet M, Mercat A, Baudin O, Clavel M, Chatellier D, Jaber S, Rosselli S, Mancebo J, Sirodot M, Hilbert G, Bengler C, Richecoeur J, Gainnier M, Bayle F, Bourdin G, Leray V, Girard R, Baboi L, Ayzac L; PROSEVA Study Group
N Engl J Med 2013 Jun 6;368(23):2159-68. Epub 2013 May 20 doi: 10.1056/NEJMoa1214103. PMID: 23688302

Recent systematic reviews

Extracorporeal membrane oxygenation for COVID-19: a systematic review and meta-analysis.
Ramanathan K, Shekar K, Ling RR, Barbaro RP, Wong SN, Tan CS, Rochwerg B, Fernando SM, Takeda S, MacLaren G, Fan E, Brodie D
Crit Care 2021 Jun 14;25(1):211. doi: 10.1186/s13054-021-03634-1. PMID: 34127027Free PMC Article
ECMO for severe ARDS: systematic review and individual patient data meta-analysis.
Combes A, Peek GJ, Hajage D, Hardy P, Abrams D, Schmidt M, Dechartres A, Elbourne D
Intensive Care Med 2020 Nov;46(11):2048-2057. Epub 2020 Oct 6 doi: 10.1007/s00134-020-06248-3. PMID: 33021684Free PMC Article
Assessment of Therapeutic Interventions and Lung Protective Ventilation in Patients With Moderate to Severe Acute Respiratory Distress Syndrome: A Systematic Review and Network Meta-analysis.
Aoyama H, Uchida K, Aoyama K, Pechlivanoglou P, Englesakis M, Yamada Y, Fan E
JAMA Netw Open 2019 Jul 3;2(7):e198116. doi: 10.1001/jamanetworkopen.2019.8116. PMID: 31365111Free PMC Article
Venovenous extracorporeal membrane oxygenation for acute respiratory distress syndrome: a systematic review and meta-analysis.
Munshi L, Walkey A, Goligher E, Pham T, Uleryk EM, Fan E
Lancet Respir Med 2019 Feb;7(2):163-172. Epub 2019 Jan 11 doi: 10.1016/S2213-2600(18)30452-1. PMID: 30642776
Guidelines for the diagnosis and management of critical illness-related corticosteroid insufficiency (CIRCI) in critically ill patients (Part I): Society of Critical Care Medicine (SCCM) and European Society of Intensive Care Medicine (ESICM) 2017.
Annane D, Pastores SM, Rochwerg B, Arlt W, Balk RA, Beishuizen A, Briegel J, Carcillo J, Christ-Crain M, Cooper MS, Marik PE, Umberto Meduri G, Olsen KM, Rodgers S, Russell JA, Van den Berghe G
Intensive Care Med 2017 Dec;43(12):1751-1763. Epub 2017 Sep 21 doi: 10.1007/s00134-017-4919-5. PMID: 28940011

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