Mechanisms ofpathogenesis, diagnosis and treatment of acute respiratory distress syndrome. Part I

The results of long-term experimental studies and clinical observations have shown the pathophysiological and clinical significance of noncardiogenic pulmonary edema in the ARDS development. It was shown that the accumulation of the ex-travascular lung fluid is one of the leading mechanisms of the ARDS pathogenesis. Proven ability to use calculated index of the extravascular lungs fluid content as an early diagnostic criteria for ARDS. The effect of the extravascular lungs fluid accumulation on the effectiveness of certain respiratory, non-respiratory and pharmacological treatments ARDS was studied. The features of the noncardiogenic pulmonary edema development in ARDS caused by direct and indirect damaging factors was described. The algorithm for diagnosis and treatment an ARDS of different genesis based on these data was scientifically justified and developed.

acute respiratory distress syndrome, direct and indirect damaging factors, pulmonary edema, extravascular fluid in the lungs, respiratory support, positive end-expiratory pressure, open lung maneuver, prone position, Surfactant BL

1. Власенко А. В. Дифференциальная диагностика и лечение вариантов острого респираторного дистресс-синдрома. Дисс. докт. мед. наук. Москва, 2012.

2. Голубев А.М., Мороз В. В., Мещеряков Г. Н., Лысенко Д. В. Патогенез и морфология острого повреждения легких. Общая реаниматология 2005; I (5): 5-12.

3. Кассиль В.Л., Выжигина М. А., Свиридов С. Н. Что такое острый респираторный дистресс-синдром: есть ли смысл в дискуссии? Вест. интенс. тер., 2006; 4: 53-58.

4. Козлов И.А., Романов А. А. Биомеханика дыхания, внутрилегочная вода и оксигенирующая функция легких во время неосложненных операций с искусственным кровообращением. Общая реаниматология, 2007, № 3, с. 17-22.

5. Кузьков В.В., Киров М. Ю., Недашковский Э. В. Волюметрический мониторинг на основе транспульмональной термодилюции в анестезиологии и интенсивной терапии. Анест. и реаниматол 2003; 4:67-73.

6. Мороз В. В., Голубев А. М., Кузов-лев А. Н. Отек легких: классификация, механизмы развития, диагностика. Общая реаниматология 2009; (1): 83-86.

7. Немченко Н.С., Денисов А. В., Жирнова Н. А., и соавт. Ранняя функционально-лабораторная диагностика ушиба легких у пострадавших с тяжелой сочетанной травмой. Вестник Военно-Медицинской Академии, 2013, 53-53.

8. Николаенко Э. М. Управление функцией легких в послеоперационный период после протезирования клапанов сердца. Дис. док. мед. наук. Москва, 1989.

9. Саенко Л.С., Тюрин И. Н. Внесосудистая вода в легких у больных с абдоминальным сепсисом. Инфекции в хирургии, 2012; (4): 54-56.

10. Чурляев Ю.А., Вереин М. Ю., Кан С.Л. и соавт. Острый респираторный дистресс-синдром при тяжелой черепно-мозговой травме. Общая реаниматология 2009; (2): 21-26.

11. Яковлев В.Н., Алексеев В. Г., Мороз В. В., Власенко А. В. Токсический отек легких и острый респираторный дистресс-синдром: диагностика и лечение. Московский медицинский журнал 2012; 12: 5-15.

12. Brown L.M., Calfee C. S., Howard J. P., Craig T. R., Matthay M. A., McAuley D. F. Comparison of thermodilution measured extravascular lung water with chest radiographic assessment of pulmonary oedema in patients with acute lung injury. Ann Intensive Care. 2013; 3: 25-27.

13. Chew M.S., Ihrman L., During J., et al. Extravascular lung water index improves the diagnostic accuracy of lung injury in patients with shock. Crit Care. 2012; 16: 11-17.

14. Craig T.R., Duffy M.J., Shyamsundar M., et al. Extravascular lung water indexed to predicted body weight is a novel predictor of intensive care unit mortality in patients with acute lung injury. Crit Care Med. 2010; 38: 114-120.

15. Groeneveld A.B., Verheij J. Extravascular lung water to blood volume ratios as measures of permeability in sepsis-induced ALI/ARDS. Intensive Care Med. 2006; 32: 1315-1321.

16. Huber W., Mair S., Gotz S. Q., et al. Extravascular lung water and its association with weight, height, age, and gender: a study in intensive care unit patients. Intensive Care Med. 2013; 39: 146-150.

17. Huber W., Hollthaler J., Schuster T., et al. Association between different indexations of extravascular lung water (EVLW) and PaO2/ FiO2. a two-center study in 231 patients. PLoS One. 2014; 9: 1371-1379.

18. Jozwiak M., Silva S., Persichini R., et al. Extravascular lung water is an independent prognostic factor in patients with acute respiratory distress-syndrome. Crit Care Med. 2013; 41: 472-480.

19. Kushimoto S., Taira Y., Kitazawa Y., et al. The clinical usefulness of extravascular lung water and pulmonary vascular permeability index to diagnose and characterize pulmonary edema: a prospective multicenter study on the quantitative differential diagnostic definition for acute lung injury/acute respiratory distress syndrome. Crit Care. 2012; 16: 1186-11898.

20. Lichtenstein DA. Lung ultrasound in the critically ill. Ann Intensive Care. 2014; 4: 11-17.

21. Muller-Leisse C., Klosterhalfen B., Hauptmann S. Computed tomography and histologic results in the early stages of endotoxin-injury lungs as a model for adult respiratory distress syndrome. Invest. Radiol. 2003; 28: 39-45.

22. Perel A. Extravascular lung water and the pulmonary vascular permeability index may improve the definition of ARDS. Crit Care. 2013; 17: 108-115.

23. Phillips C. R. The Berlin definition: real change or the emperor's new clothes? Crit. Care. 2013; 17: 174-176.

24. Sakka S. G. Extravascular lung water in ARDS patients. Minerva Anestesiol. 2013; 79: 274-284.

25. Tagami T, Nakamura T, Kushimoto S, et al. Early-phase changes of extravascular lung water index as a prognostic indicator in acute respiratory distress syndrome patients. Ann. Intensive Care. 2014; 4: 27-31.

26. Thille A.W., Esteban A., Fernandez-Segoviano P., et al. Comparison of the Berlin definition for acute respiratory distress syndrome with autopsy. Am.J. Respir. Crit. Care Med. 2013; 187:761-767.

27. Villar J., Slutsky A. S. Is acute respiratory distress syndrome an iatrogenic disease? Crit. Care. 2010; 14 (1): 120-125.

28. Villar J., Blanco J., Kacmarek R. M. Acute respiratory distress syndrome definition: do we need a change? Current Opinion in Critical Care, 2011; 17: 13-17.

29. Zhang 1., Lu B, Ni H. Prognostic value of extravascular lung water index in critically ill patients: A systematic review of the literature. J. Crit. Care. 2014; 16: 1112-1117.