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Semin Respir Crit Care Med 2019; 40(01): 031-039
DOI: 10.1055/s-0039-1683996
Review Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Pathogenesis of Acute Respiratory Distress Syndrome

Laura A. Huppert
1   Department of Medicine, University of California, San Francisco, San Francisco, California
,
Michael A. Matthay
2   Department of Medicine, Cardiovascular Research Institute, University of California, San Francisco, San Francisco, California
3   Department of Anesthesia, Cardiovascular Research Institute, University of California, San Francisco, San Francisco, California
,
Lorraine B. Ware
4   Division of Allergy, Pulmonary, and Critical Care Medicine, Department of Medicine, Vanderbilt University School of Medicine, Nashville, Tennessee
› Author Affiliations
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Publication History

Publication Date:
06 May 2019 (online)

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Abstract

Acute respiratory distress syndrome (ARDS) is a syndrome of acute respiratory failure caused by noncardiogenic pulmonary edema. Despite five decades of basic and clinical research, there is still no effective pharmacotherapy for this condition and the treatment remains primarily supportive. It is critical to study the molecular and physiologic mechanisms that cause ARDS to improve our understanding of this syndrome and reduce mortality. The goal of this review is to describe our current understanding of the pathogenesis and pathophysiology of ARDS. First, we will describe how pulmonary edema fluid accumulates in ARDS due to lung inflammation and increased alveolar endothelial and epithelial permeabilities. Next, we will review how pulmonary edema fluid is normally cleared in the uninjured lung, and describe how these pathways are disrupted in ARDS. Finally, we will explain how clinical trials and preclinical studies of novel therapeutic agents have further refined our understanding of this condition, highlighting, in particular, the study of mesenchymal stromal cells in the treatment of ARDS.

Keywords

acute respiratory distress syndrome - alveolar fluid clearance - vectorial ion transport - pulmonary edema - mesenchymal stromal cells
 

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