Acute respiratory distress syndrome
Ensuring healthy lives and promoting the well-being at all ages is the aim of UN Sustainable Development Goal 3. Here, we talk to Dr Michael Matthay about acute respiratory distress syndrome (ARDS), and how developments in basic and clinical research can help address the global targets for healthy living.
Q: What is ARDS?
A: ARDS is a major cause of acute respiratory failure that affects adults and children, most commonly from severe pneumonia, sepsis from a non-pulmonary source, or major trauma. Patients with ARDS experience low levels of oxygen and difficulty breathing. Mortality ranges from 25% to 45%. Treatment at the hospital is required in an intensive care unit with the capacity to provide positive-pressure ventilation with supplemental oxygen, antibiotics (usually), monitoring and treatment for multiple organ failure.
Q: When thinking about the specific targets of Goal 3 of the SDGs, can you comment on how aligned these are with the global research picture for ARDS?
A: One target for earlier recognition of ARDS on a global scale is to use methods that are suitable for low-resource settings, including oxygen saturation monitoring (instead of relying on arterial blood gases) and ultrasound of the thorax if chest radiographs are not available. This approach is described as the Kigali modification of the Berlin definition of ARDS, and fits well with the global aim to improve access to reliable healthcare.
Another research and clinical priority is to recognize that the diagnosis of ARDS should be accompanied by an effort to diagnose a treatable infection as the primary cause (including bacterial pneumonia, malaria, or soft-tissue infections that may require source control with surgery), which completely aligns with the goals to eradicate infectious diseases by 2030.
Additionally, there is a goal to reduce the risk of major trauma, an important cause of ARDS. This goal can be achieved by reducing road accidents and increasing the use of seat belts and other measures to make driving trucks and automobiles safer. This objective can be advanced by all nations to institute methods to make driving of automobiles and trucks safer.
Q: What do you envision as the future for treating patients with ARDS?
A: I believe that the future for treating ARDS will include more uniform adherence to the proven value of early institution of lung-protective ventilation for treatment of ARDS. Our Primer shows that the adoption of lung protective ventilation world-wide has been suboptimal. My second goal for future treatment of ARDS is to recognize the heterogeneity in the causes, pathogenesis and outcomes of ARDS so that specific pharmacologic treatments can be utilized to further reduce morbidity and mortality. In addition, earlier recognition of ARDS before the patient requires positive-pressure ventilation may also reduce the development of full-blown ARDS, especially by earlier treatments in the emergency department. The use of high-flow nasal oxygen has already had a transforming effect on treating early hypoxaemic respiratory failure prior to ARDS by reducing mortality in these patients, most of whom have pneumonia (discussed in our article).
To learn more about ARDS, read the Primer published in Nature Reviews Disease Primers
Michael Matthay is at UCSF (https://profiles.ucsf.edu/michael.matthay)