Fatma YILDIRIM, İrem KARAMAN, Akın KAYA

Current situation in ARDS in the light of recent studies: Classification, epidemiology and pharmacotherapeutics

Current situation in ARDS in the light of recent studies: Classification, epidemiology and pharmacotherapeutics In the last 50 years, there have been great research and developments in the definition and pathophysiology of acute respiratory distress syndrome (ARDS), the most progressive form of acute hypoxemic respiratory failure. Although there are various discussions and recommendations, the definition of ARDS is still based on the Berlin 2012 diagnostic criteria. Despite various studies in recent years, there is still no effective pharmacotherapeutic agent for the treatment of ARDS. Lung protective mechanical ventilation (low tidal volume, low plateau pressure, low driving pressure) in all ARDS patients, prone position, neuromuscular blockade (cisatracurium) in moderate-severe ARDS patients, and hydrocortisone therapy in sepsis-associated ARDS patients are treatments that contribute to survival. In this review, current changes in the definition and epidemiology of ARDS, recent pharmacotherapeutic research and mesenchymal stem cell therapies will be discussed in the light of newly introduced ARDS phenotypes.

Güncel çalışmalar ışığında ARDS’de mevcut durum: Sınıflandırma, epidemiyoloji ve farmakoterapötikler

Akut hipoksemik solunum yetmezliğinin en progresif formu olan akut solunum sıkıntısı sendromunun (ARDS) tanımı ve patofizyolojisi konusunda son 50 yılda büyük araştırmalar ve gelişmeler olmuştur. ARDS tanımı halen üzerinde çeşitli tartışma ve öneriler olmasına rağmen Berlin 2012 tanı kriterlerine dayanmaktadır. Son yıllardaki çeşitli araştırmalara rağmen ARDS tedavisinde etkin bir farmakoterapötik ajan halen bulunmamaktadır. Tüm ARDS hastalarında akciğer koruyucu mekanik ventilasyon (düşük tidal volüm, düşük plato basıncı, düşük sürücü basınç); orta-ağır ARDS hastalarında pron pozisyon, nöromüskuler blökor (sisatraküryum) ve sepsis ilişkili ARDS hastalarında hidrokortizon tedavisi sağkalıma fayda sağlayan tedavilerdir. Bu derlemede ARDS tanımındaki ve epidemiyolojisindeki günümüze kadar olan değişiklikler, tedavideki farmakoterapötik son araştırmalar ve mezenkimal kök hücre tedavileri yeni ortaya atılan ARDS fenotipleri eşliğinde tartışılacaktır.

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