1. Cheema, Tariq MD, FCCP
  2. Issue Editor

Article Content

Acute respiratory distress syndrome (ARDS) was first described by Ashbaugh in 1967 and over the past 6 decades, there have been many advancements in the treatment of this deadly disease.


As our population is rapidly aging and we are seeing increased utilization of intensive care unit services, focus on standardizing care of all major diseases is one of the most common diagnoses seen in intensive care units around the world.


The ARDSNet trial published in The New England Journal of Medicine in 2000 was the first major trial that showed a mortality benefit by specific ventilator interventions such as low tidal volume strategy. In the last couple of decades, we have learned a lot from our shared experiences and this edition of Critical Care Nursing Quarterly sheds light on the advancements in the care of ARDS.


In our introductory article, we give an overview of ARDS. We define the disease and explore the causes (both pulmonary and extrapulmonary) and review the pathophysiology of how ARDS develops with a special nursing perceptive by a critical care nurse.


The next article titled, "Mechanical Ventilation in ARDS," will explore mechanical ventilation management in ARDS and the concepts surrounding low tidal volume strategies, positive end-expiratory pressure, and driving pressures. We also discuss how mechanical ventilation has effects on the pulmonary, neurological, and cardiovascular systems. We compare some of the different modes of ventilation. We also provide summary recommendations on mechanical ventilator use.


In the article titled, "Paralytics, Sedation, and Steroids in ARDS," we take an in-depth look at individual therapies and their effects. We also explore the controversies around steroid use in ARDS to clarify the current guidelines and recommendations.


In article titled, "Prone Positioning in ARDS," we review the pathophysiology of gas exchange and review studies involving the use of prone ventilation. We also give an outline to a practical approach to manage patients requiring prone ventilation.


The article titled "Mimics of Acute Respiratory Distress Syndrome" navigates us through the differential diagnosis of ARDS and we discuss the similarities and differences of each of these diseases so that we can get a better understanding on how to distinguish from ARDS.


Complications of ARDS highlight the fact that despite all the advancement in treatment, mortality from ARDS remains around 40%. This article explores the risk factors associated with short-term and long-term complications of ARDS. We hope to help guide identification, prevention, and treatment of these complications to reduce overall mortality.


Extra-corporeal membrane oxygenation (ECMO) in ARDS will be a thorough overview of ECMO. We start with the history of ECMO and then describe the principles of its use. We also review the process of patient selection, followed by types of ECMO and its potential complications. We review the landmark studies involving ECMO.


In the article titled, "ARDS Novel Therapies," we discuss the use of therapies, such as aspirin, nitric oxide, and stem cells, and review the literature and evidence supporting their use.


We include an article titled, "Acute Respiratory Distress Syndrome from an Infectious Disease Perspective," in which our infectious disease colleagues will discuss infectious etiologies and management.


We have included an article titled, "Acute Kidney Injury in the Context of Acute Respiratory Distress Syndrome," which gives us an overview of kidney injury in the critically ill patient and reviews dialysis modes. We focus on fluid status management in ARDS patient.


In the final article titled, "Cardiac Dysfunction in Acute Respiratory Distress Syndrome," we examine the cardiac effects of ARDS with a focus on the right-sided heart function and some echocardiographic findings.


-Tariq Cheema, MD, FCCP


Issue Editor