Diagnostic workup for ARDS patients

Laurent Papazian, Carolyn S. Calfee, Davide Chiumello, Charles Edouard Luyt, Nuala J. Meyer, Hiroshi Sekiguchi, Michael A. Matthay, Gianfranco Meduri

Research output: Contribution to journalReview article

25 Citations (Scopus)

Abstract

Acute respiratory distress syndrome (ARDS) is defined by the association of bilateral infiltrates and hypoxaemia following an initial insult. Although a new definition has been recently proposed (Berlin definition), there are various forms of ARDS with potential differences regarding their management (ventilator settings, prone positioning use, corticosteroids). ARDS can be caused by various aetiologies, and the adequate treatment of the responsible cause is crucial to improve the outcome. It is of paramount importance to characterize the mechanisms causing lung injury to optimize both the aetiological treatment and the symptomatic treatment. If there is no obvious cause of ARDS or if a direct lung injury is suspected, bronchoalveolar lavage (BAL) should be strongly considered to identify microorganisms responsible for pneumonia. Blood samples can also help to identify microorganisms and to evaluate biomarkers of infection. If there is no infectious cause of ARDS or no other apparent aetiology is found, second-line examinations should include markers of immunologic diseases. In selected cases, open lung biopsy remains useful to identify the cause of ARDS when all other examinations remain inconclusive. CT scan is fundamental when there is a suspicion of intra-abdominal sepsis and in some cases of pneumonia. Ultrasonography is important not only in evaluating biventricular function but also in identifying pleural effusions and pneumothorax. The definition of ARDS remains clinical and the main objective of the diagnostic workup should be to be focused on identification of its aetiology, especially a treatable infection.

Original languageEnglish (US)
Pages (from-to)674-685
Number of pages12
JournalIntensive care medicine
Volume42
Issue number5
DOIs
StatePublished - May 1 2016

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Adult Respiratory Distress Syndrome
Lung Injury
Pneumonia
Immune System Diseases
Bronchoalveolar Lavage
Berlin
Pneumothorax
Pleural Effusion
Mechanical Ventilators
Infection
Ultrasonography
Sepsis
Adrenal Cortex Hormones
Therapeutics
Biomarkers
Biopsy
Lung

All Science Journal Classification (ASJC) codes

  • Critical Care and Intensive Care Medicine

Cite this

Papazian, L., Calfee, C. S., Chiumello, D., Luyt, C. E., Meyer, N. J., Sekiguchi, H., ... Meduri, G. (2016). Diagnostic workup for ARDS patients. Intensive care medicine, 42(5), 674-685. https://doi.org/10.1007/s00134-016-4324-5

Diagnostic workup for ARDS patients. / Papazian, Laurent; Calfee, Carolyn S.; Chiumello, Davide; Luyt, Charles Edouard; Meyer, Nuala J.; Sekiguchi, Hiroshi; Matthay, Michael A.; Meduri, Gianfranco.

In: Intensive care medicine, Vol. 42, No. 5, 01.05.2016, p. 674-685.

Research output: Contribution to journalReview article

Papazian, L, Calfee, CS, Chiumello, D, Luyt, CE, Meyer, NJ, Sekiguchi, H, Matthay, MA & Meduri, G 2016, 'Diagnostic workup for ARDS patients', Intensive care medicine, vol. 42, no. 5, pp. 674-685. https://doi.org/10.1007/s00134-016-4324-5
Papazian L, Calfee CS, Chiumello D, Luyt CE, Meyer NJ, Sekiguchi H et al. Diagnostic workup for ARDS patients. Intensive care medicine. 2016 May 1;42(5):674-685. https://doi.org/10.1007/s00134-016-4324-5
Papazian, Laurent ; Calfee, Carolyn S. ; Chiumello, Davide ; Luyt, Charles Edouard ; Meyer, Nuala J. ; Sekiguchi, Hiroshi ; Matthay, Michael A. ; Meduri, Gianfranco. / Diagnostic workup for ARDS patients. In: Intensive care medicine. 2016 ; Vol. 42, No. 5. pp. 674-685.
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