2021 Acute Respiratory Distress Syndrome (ARDS) Update with COVID 19 Focus

Welker, Carson; Huang, Jeffrey; Gil, Iván J Núñez; Ramakrishna, Harish

Acute Respiratory Distress Syndrome (ARDS) is a heterogeneous lung disease responsible for significant morbidity and mortality among critically ill patients, including those infected with SARS-CoV-2, the virus responsible for COVID-19. Despite recent advances in pathophysiology, diagnostics, and therapeutics, ARDS is dangerously underdiagnosed and supportive lung protective ventilation and prone position remain the mainstay intervention. Rescue therapies including neuromuscular blockade and veno-venous extracorporeal membrane oxygenation (VV-ECMO) remain a key component of clinical practice though benefits are uncertain. While COVID-19 ARDS has some distinguishing features from traditional ARDS, including delayed onset, hyperinflammatory response, and pulmonary microthrombi, it is clinically similar to traditional ARDS and should be treated with established supportive therapies.