Top

Published in:

01-05-2016 | Review

Diagnostic workup for ARDS patients

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

Published in: Intensive Care Medicine | Issue 5/2016

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.

Available only for authorised users

Ferguson ND, Fan E, Camporota L, Antonelli M, Anzueto A, Beale R, Brochard L, Brower R, Esteban A, Gattinoni L, Rhodes A, Slutsky AS, Vincent JL, Rubenfeld GD, Thompson BT, Ranieri VM (2012) The Berlin definition of ARDS: an expanded rationale, justification, and supplementary material. Intensive Care Med 38:1573–1582CrossRefPubMed

Force ADT, Ranieri VM, Rubenfeld GD, Thompson BT, Ferguson ND, Caldwell E, Fan E, Camporota L, Slutsky AS (2012) Acute respiratory distress syndrome: the Berlin definition. JAMA 307:2526–2533

Bellani G, Laffey JG, Pham T, Fan E, Brochard L, Esteban A, Gattinoni L, van Haren F, Larsson A, McAuley DF, Ranieri M, Rubenfeld G, Thompson BT, Wrigge H, Slutsky AS, Pesenti A, LUNG SAFE Investigators, ESICM Trials Group (2016) Epidemiology, patterns of care, and mortality for patients with acute respiratory distress syndrome in intensive care units in 50 countries. JAMA 315:788–800CrossRefPubMed

Piantadosi CA, Schwartz DA (2004) The acute respiratory distress syndrome. Ann Intern Med 141:460–470CrossRefPubMed

Chastre J, Trouillet JL, Vuagnat A, Joly-Guillou ML, Clavier H, Dombret MC, Gibert C (1998) Nosocomial pneumonia in patients with acute respiratory distress syndrome. Am J Respir Crit Care Med 157:1165–1172CrossRefPubMed

de Roux A, Marcos MA, Garcia E, Mensa J, Ewig S, Lode H, Torres A (2004) Viral community-acquired pneumonia in nonimmunocompromised adults. Chest 125:1343–1351CrossRefPubMed

Jennings LC, Anderson TP, Beynon KA, Chua A, Laing RT, Werno AM, Young SA, Chambers ST, Murdoch DR (2008) Incidence and characteristics of viral community-acquired pneumonia in adults. Thorax 63:42–48CrossRefPubMed

Luyt CE, Combes A, Trouillet JL, Nieszkowska A, Chastre J (2011) Virus-induced acute respiratory distress syndrome: epidemiology, management and outcome. Presse Med 40:e561–e568CrossRefPubMed

Choi SH, Hong SB, Ko GB, Lee Y, Park HJ, Park SY, Moon SM, Cho OH, Park KH, Chong YP, Kim SH, Huh JW, Sung H, Do KH, Lee SO, Kim MN, Jeong JY, Lim CM, Kim YS, Woo JH, Koh Y (2012) Viral infection in patients with severe pneumonia requiring intensive care unit admission. Am J Respir Crit Care Med 186:325–332CrossRefPubMed

10.

Writing Committee of the WHO Consultation on Clinical Aspects of Pandemic (H1N1) 2009 Influenza, Bautista E, Bautista E, Chotpitayasunondh T, Gao Z, Harper SA, Shaw M, Uyeki TM, Zaki SR, Hayden FG, Hui DS, Kettner JD, Kumar A, Lim M, Shindo N, Penn C, Nicholson KG (2010) Clinical aspects of pandemic 2009 influenza A (H1N1) virus infection. N Engl J Med 362:1708–1719CrossRef

11.

Tuxen DV, Cade JF, McDonald MI, Buchanan MR, Clark RJ, Pain MC (1982) Herpes simplex virus from the lower respiratory tract in adult respiratory distress syndrome. Am Rev Respir Dis 126:416–419PubMed

12.

Luyt CE, Combes A, Deback C, Aubriot-Lorton MH, Nieszkowska A, Trouillet JL, Capron F, Agut H, Gibert C, Chastre J (2007) Herpes simplex virus lung infection in patients undergoing prolonged mechanical ventilation. Am J Respir Crit Care Med 175:935–942CrossRefPubMed

13.

Papazian L, Doddoli C, Chetaille B, Gernez Y, Thirion X, Roch A, Donati Y, Bonnety M, Zandotti C, Thomas P (2007) A contributive result of open-lung biopsy improves survival in acute respiratory distress syndrome patients. Crit Care Med 35:755–762CrossRefPubMed

14.

Limaye AP, Kirby KA, Rubenfeld GD, Leisenring WM, Bulger EM, Neff MJ, Gibran NS, Huang ML, Santo Hayes TK, Corey L, Boeckh M (2008) Cytomegalovirus reactivation in critically ill immunocompetent patients. JAMA 300:413–422CrossRefPubMedPubMedCentral

15.

Papazian L, Fraisse A, Garbe L, Zandotti C, Thomas P, Saux P, Pierrin G, Gouin F (1996) Cytomegalovirus. An unexpected cause of ventilator-associated pneumonia. Anesthesiology 84:280–287CrossRefPubMed

16.

Papazian L, Hraiech S, Lehingue S, Roch A, Chiche L, Wiramus S, Forel JM (2016) Cytomegalovirus reactivation in ICU patients. Intensive Care Med 42:28–37CrossRefPubMed

17.

Azoulay E, Lemiale V, Mokart D, Pene F, Kouatchet A, Perez P, Vincent F, Mayaux J, Benoit D, Bruneel F, Meert AP, Nyunga M, Rabbat A, Darmon M (2014) Acute respiratory distress syndrome in patients with malignancies. Intensive Care Med 40:1106–1114CrossRefPubMed

18.

Gadsby NJ, Helgason KO, Dickson EM, Mills JM, Lindsay DS, Edwards GF, Hanson MF, Templeton KE, ESCMID Study Group for Molecular Diagnostics, ESCMID Study Group for Legionella Infections, Basel, Switzerland (2016) Molecular diagnosis of Legionella infections—clinical utility of front-line screening as part of a pneumonia diagnostic algorithm. J Infect 72:161–170CrossRefPubMed

19.

Chastre J, Fagon JY (2002) Ventilator-associated pneumonia. Am J Respir Crit Care Med 165:867–903CrossRefPubMed

20.

Gadsby NJ, Russell CD, McHugh MP, Mark H, Conway Morris A, Laurenson IF, Hill AT, Templeton KE (2016) Comprehensive molecular testing for respiratory pathogens in community-acquired pneumonia. Clin Infect Dis 62:817–823

21.

Sasso M, Chastang-Dumas E, Bastide S, Alonso S, Lechiche C, Bourgeois N, Lachaud L (2016) Performances of four real-time PCR assays for the diagnosis of Pneumocystis jirovecii pneumonia. J Clin Microbiol 54:625–630

22.

Winer-Muram HT, Rubin SA, Ellis JV, Jennings SG, Arheart KL, Wunderink RG, Leeper KV, Meduri GU (1993) Pneumonia and ARDS in patients receiving mechanical ventilation: diagnostic accuracy of chest radiography. Radiology 188:479–485CrossRefPubMed

23.

Meduri GU, Mauldin GL, Wunderink RG, Leeper KV Jr, Jones CB, Tolley E, Mayhall G (1994) Causes of fever and pulmonary densities in patients with clinical manifestations of ventilator-associated pneumonia. Chest 106:221–235CrossRefPubMed

24.

Luyt CE, Combes A, Nieszkowska A, Trouillet JL, Chastre J (2008) Viral infections in the ICU. Curr Opin Crit Care 14:605–608CrossRefPubMed

25.

Hotchkiss RS, Monneret G, Payen D (2013) Immunosuppression in sepsis: a novel understanding of the disorder and a new therapeutic approach. Lancet Infect Dis 13:260–268CrossRefPubMedPubMedCentral

26.

Chiche L, Forel JM, Roch A, Guervilly C, Pauly V, Allardet-Servent J, Gainnier M, Zandotti C, Papazian L (2009) Active cytomegalovirus infection is common in mechanically ventilated medical intensive care unit patients. Crit Care Med 37:1850–1857CrossRefPubMed

27.

Meduri GU, Reddy RC, Stanley T, El-Zeky F (1998) Pneumonia in acute respiratory distress syndrome. A prospective evaluation of bilateral bronchoscopic sampling. Am J Respir Crit Care Med 158:870–875CrossRefPubMed

28.

Meduri GU, Bridges L, Shih MC, Marik PE, Siemieniuk RA, Kocak M (2015) Prolonged glucocorticoid treatment is associated with improved ARDS outcomes: analysis of individual patients’ data from four randomized trials and trial-level meta-analysis of the updated literature. Intensive Care Med. doi:10.1007/s00134-015-4095-4

29.

Meduri GU, Golden E, Freire AX, Taylor E, Zaman M, Carson SJ, Gibson M, Umberger R (2007) Methylprednisolone infusion in early severe ARDS: results of a randomized controlled trial. Chest 131:954–963CrossRefPubMed

30.

Meduri GU, Headley AS, Golden E, Carson SJ, Umberger RA, Kelso T, Tolley EA (1998) Effect of prolonged methylprednisolone therapy in unresolving acute respiratory distress syndrome: a randomized controlled trial. JAMA 280:159–165CrossRefPubMed

31.

Gibelin A, Parrot A, Maitre B, Brun-Buisson C, Mekontso Dessap A, Fartoukh M, de Prost N (2016) Acute respiratory distress syndrome mimickers lacking common risk factors of the Berlin definition. Intensive Care Med 42:164–172CrossRefPubMed

32.

Meduri GU, Annane D, Chrousos GP, Marik PE, Sinclair SE (2009) Activation and regulation of systemic inflammation in ARDS: rationale for prolonged glucocorticoid therapy. Chest 136:1631–1643CrossRefPubMed

33.

Meduri GU, Eltorky MA (2015) Understanding ARDS-associated fibroproliferation. Intensive Care Med 41:517–520CrossRefPubMed

34.

Murray JF, Matthay MA, Luce JM, Flick MR (1988) An expanded definition of the adult respiratory distress syndrome. Am Rev Respir Dis 138:720–723CrossRefPubMed

35.

Clark JG, Milberg JA, Steinberg KP, Hudson LD (1995) Type III procollagen peptide in the adult respiratory distress syndrome. Association of increased peptide levels in bronchoalveolar lavage fluid with increased risk for death. Ann Intern Med 122:17–23CrossRefPubMed

36.

Meduri GU, Headley S, Kohler G, Stentz F, Tolley E, Umberger R, Leeper K (1995) Persistent elevation of inflammatory cytokines predicts a poor outcome in ARDS. Plasma IL-1 beta and IL-6 levels are consistent and efficient predictors of outcome over time. Chest 107:1062–1073CrossRefPubMed

37.

Meduri GU, Kohler G, Headley S, Tolley E, Stentz F, Postlethwaite A (1995) Inflammatory cytokines in the BAL of patients with ARDS. Persistent elevation over time predicts poor outcome. Chest 108:1303–1314CrossRefPubMed

38.

Steinberg KP, Milberg JA, Martin TR, Maunder RJ, Cockrill BA, Hudson LD (1994) Evolution of bronchoalveolar cell populations in the adult respiratory distress syndrome. Am J Respir Crit Care Med 150:113–122CrossRefPubMed

39.

Chesnutt AN, Matthay MA, Tibayan FA, Clark JG (1997) Early detection of type III procollagen peptide in acute lung injury. Pathogenetic and prognostic significance. Am J Respir Crit Care Med 156:840–845CrossRefPubMed

40.

Meduri GU, Tolley EA, Chinn A, Stentz F, Postlethwaite A (1998) Procollagen types I and III aminoterminal propeptide levels during acute respiratory distress syndrome and in response to methylprednisolone treatment. Am J Respir Crit Care Med 158:1432–1441CrossRefPubMed

41.

Forel JM, Guervilly C, Hraiech S, Voillet F, Thomas G, Somma C, Secq V, Farnarier C, Payan MJ, Donati SY, Perrin G, Trousse D, Dizier S, Chiche L, Baumstarck K, Roch A, Papazian L (2015) Type III procollagen is a reliable marker of ARDS-associated lung fibroproliferation. Intensive Care Med 41:1–11CrossRefPubMed

42.

Ashbaugh DG, Bigelow DB, Petty TL, Levine BE (1967) Acute respiratory distress in adults. Lancet 2:319–323CrossRefPubMed

43.

Katzenstein AL, Bloor CM, Leibow AA (1976) Diffuse alveolar damage—the role of oxygen, shock, and related factors. A review. Am J Pathol 85:209–228PubMedPubMedCentral

44.

Pratt PC, Vollmer RT, Shelburne JD, Crapo JD (1979) Pulmonary morphology in a multihospital collaborative extracorporeal membrane oxygenation project. I. Light microscopy. Am J Pathol 95:191–214PubMedPubMedCentral

45.

Thille AW, Esteban A, Fernandez-Segoviano P, Rodriguez JM, Aramburu JA, Penuelas O, Cortes-Puch I, Cardinal-Fernandez P, Lorente JA, Frutos-Vivar F (2013) Comparison of the Berlin definition for acute respiratory distress syndrome with autopsy. Am J Respir Crit Care Med 187:761–767CrossRefPubMed

46.

Lorente JA, Cardinal-Fernandez P, Munoz D, Frutos-Vivar F, Thille AW, Jaramillo C, Ballen-Barragan A, Rodriguez JM, Penuelas O, Ortiz G, Blanco J, Pinheiro BV, Nin N, del Carmen Marin M, Esteban A, Thompson TB (2015) Acute respiratory distress syndrome in patients with and without diffuse alveolar damage: an autopsy study. Intensive Care Med 41:1921–1930CrossRefPubMed

47.

Thille AW, Esteban A, Fernandez-Segoviano P, Rodriguez JM, Aramburu JA, Vargas-Errazuriz P, Martin-Pellicer A, Lorente JA, Frutos-Vivar F (2013) Chronology of histological lesions in acute respiratory distress syndrome with diffuse alveolar damage: a prospective cohort study of clinical autopsies. Lancet Respir Med 1:395–401CrossRefPubMed

48.

Ware LB (2013) Autopsy in ARDS: insights into natural history. Lancet Respir Med 1:352–354CrossRefPubMed

49.

Palakshappa JA, Meyer NJ (2015) Which patients with ARDS benefit from lung biopsy? Chest 148:1073–1082CrossRefPubMed

50.

Gattinoni L, Caironi P, Pelosi P, Goodman LR (2001) What has computed tomography taught us about the acute respiratory distress syndrome? Am J Respir Crit Care Med 164:1701–1711CrossRefPubMed

51.

Pelosi P, D’Andrea L, Vitale G, Pesenti A, Gattinoni L (1994) Vertical gradient of regional lung inflation in adult respiratory distress syndrome. Am J Respir Crit Care Med 149:8–13CrossRefPubMed

52.

Cressoni M, Cadringher P, Chiurazzi C, Amini M, Gallazzi E, Marino A, Brioni M, Carlesso E, Chiumello D, Quintel M, Bugedo G, Gattinoni L (2014) Lung inhomogeneity in patients with acute respiratory distress syndrome. Am J Respir Crit Care Med 189:149–158PubMed

53.

Goodman LR, Fumagalli R, Tagliabue P, Tagliabue M, Ferrario M, Gattinoni L, Pesenti A (1999) Adult respiratory distress syndrome due to pulmonary and extrapulmonary causes: CT, clinical, and functional correlations. Radiology 213:545–552CrossRefPubMed

54.

Gattinoni L, Mascheroni D, Torresin A, Marcolin R, Fumagalli R, Vesconi S, Rossi GP, Rossi F, Baglioni S, Bassi F et al (1986) Morphological response to positive end expiratory pressure in acute respiratory failure. Computerized tomography study. Intensive Care Med 12:137–142CrossRefPubMed

55.

Chiumello D, Langer T, Vecchi V, Luoni S, Colombo A, Brioni M, Froio S, Cigada I, Coppola S, Protti A, Lazzerini M, Gattinoni L (2014) Low-dose chest computed tomography for quantitative and visual anatomical analysis in patients with acute respiratory distress syndrome. Intensive Care Med 40:691–699CrossRefPubMed

56.

Chiumello D, Marino A, Brioni M, Menga F, Cigada I, Lazzerini M, Andrisani MC, Biondetti P, Cesana B, Gattinoni L (2013) Visual anatomical lung CT scan assessment of lung recruitability. Intensive Care Med 39:66–73CrossRefPubMed

57.

Lichtenstein DA (2007) Ultrasound in the management of thoracic disease. Crit Care Med 35:S250–S261CrossRefPubMed

58.

Volpicelli G, Elbarbary M, Blaivas M, Lichtenstein DA, Mathis G, Kirkpatrick AW, Melniker L, Gargani L, Noble VE, Via G, Dean A, Tsung JW, Soldati G, Copetti R, Bouhemad B, Reissig A, Agricola E, Rouby JJ, Arbelot C, Liteplo A, Sargsyan A, Silva F, Hoppmann R, Breitkreutz R, Seibel A, Neri L, Storti E, Petrovic T, International Liaison Committee on Lung Ultrasound for International Consensus Conference on Lung Ultrasound (ICC-LUS) (2012) International evidence-based recommendations for point-of-care lung ultrasound. Intensive Care Med 38:577–591CrossRefPubMed

59.

Lichtenstein DA, Meziere GA (2008) Relevance of lung ultrasound in the diagnosis of acute respiratory failure: the BLUE protocol. Chest 134:117–125CrossRefPubMedPubMedCentral

60.

Gargani L, Lionetti V, Di Cristofano C, Bevilacqua G, Recchia FA, Picano E (2007) Early detection of acute lung injury uncoupled to hypoxemia in pigs using ultrasound lung comets. Crit Care Med 35:2769–2774CrossRefPubMed

61.

Copetti R, Soldati G, Copetti P (2008) Chest sonography: a useful tool to differentiate acute cardiogenic pulmonary edema from acute respiratory distress syndrome. Cardiovasc Ultrasound 6:16CrossRefPubMedPubMedCentral

62.

Sekiguchi H, Schenck LA, Horie R, Suzuki J, Lee EH, McMenomy BP, Chen TE, Lekah A, Mankad SV, Gajic O (2015) Critical care ultrasonography differentiates ARDS, pulmonary edema, and other causes in the early course of acute hypoxemic respiratory failure. Chest 148:912–918CrossRefPubMed

63.

Bouhemad B, Liu ZH, Arbelot C, Zhang M, Ferarri F, Le-Guen M, Girard M, Lu Q, Rouby JJ (2010) Ultrasound assessment of antibiotic-induced pulmonary reaeration in ventilator-associated pneumonia. Crit Care Med 38:84–92CrossRefPubMed

64.

Peris A, Zagli G, Barbani F, Tutino L, Biondi S, di Valvasone S, Batacchi S, Bonizzoli M, Spina R, Miniati M, Pappagallo S, Giovannini V, Gensini GF (2010) The value of lung ultrasound monitoring in H1N1 acute respiratory distress syndrome. Anaesthesia 65:294–297CrossRefPubMed

65.

Bouhemad B, Brisson H, Le-Guen M, Arbelot C, Lu Q, Rouby JJ (2011) Bedside ultrasound assessment of positive end-expiratory pressure-induced lung recruitment. Am J Respir Crit Care Med 183:341–347CrossRefPubMed

66.

Camporota L, Smith J, Barrett N, Beale R (2012) Assessment of regional lung mechanics with electrical impedance tomography can determine the requirement for ECMO in patients with severe ARDS. Intensive Care Med 38:2086–2087CrossRefPubMed

67.

Bernard GR, Artigas A, Brigham KL, Carlet J, Falke K, Hudson L, Lamy M, Legall JR, Morris A, Spragg R (1994) The American-European Consensus Conference on ARDS. Definitions, mechanisms, relevant outcomes, and clinical trial coordination. Am J Respir Crit Care Med 149:818–824CrossRefPubMed

68.

Guerin C, Reignier J, Richard JC, Beuret P, Gacouin A, Boulain T, Mercier E, Badet M, Mercat A, Baudin O, Clavel M, Chatellier D, Jaber S, Rosselli S, Mancebo J, Sirodot M, Hilbert G, Bengler C, Richecoeur J, Gainnier M, Bayle F, Bourdin G, Leray V, Girard R, Baboi L, Ayzac L, PROSEVA Study Group (2013) Prone positioning in severe acute respiratory distress syndrome. N Engl J Med 368:2159–2168CrossRefPubMed

69.

Papazian L, Forel JM, Gacouin A, Penot-Ragon C, Perrin G, Loundou A, Jaber S, Arnal JM, Perez D, Seghboyan JM, Constantin JM, Courant P, Lefrant JY, Guerin C, Prat G, Morange S, Roch A, ACURASYS Study Investigators (2010) Neuromuscular blockers in early acute respiratory distress syndrome. N Engl J Med 363:1107–1116CrossRefPubMed

70.

Calfee CS, Eisner MD, Ware LB, Thompson BT, Parsons PE, Wheeler AP, Korpak A, Matthay MA, Acute Respiratory Distress Syndrome Network, National Heart, Lung, and Blood Institute (2007) Trauma-associated lung injury differs clinically and biologically from acute lung injury due to other clinical disorders. Crit Care Med 35:2243–2250CrossRefPubMedPubMedCentral

71.

Calfee CS, Janz DR, Bernard GR, May AK, Kangelaris KN, Matthay MA, Ware LB, NIH NHLBI ARDS Network (2015) Distinct molecular phenotypes of direct vs indirect ARDS in single-center and multicenter studies. Chest 147:1539–1548CrossRefPubMed

72.

Schmidt EP, Li G, Li L, Fu L, Yang Y, Overdier KH, Douglas IS, Linhardt RJ (2014) The circulating glycosaminoglycan signature of respiratory failure in critically ill adults. J Biol Chem 289:8194–8202CrossRefPubMedPubMedCentral

73.

Jabaudon M, Blondonnet R, Roszyk L, Bouvier D, Audard J, Clairefond G, Fournier M, Marceau G, Dechelotte P, Pereira B, Sapin V, Constantin JM (2015) Soluble receptor for advanced glycation end-products predicts impaired alveolar fluid clearance in acute respiratory distress syndrome. Am J Respir Crit Care Med 192:191–199CrossRefPubMed

74.

Puybasset L, Gusman P, Muller JC, Cluzel P, Coriat P, Rouby JJ (2000) Regional distribution of gas and tissue in acute respiratory distress syndrome. III. Consequences for the effects of positive end-expiratory pressure. CT scan ARDS study group. Adult respiratory distress syndrome. Intensive Care Med 26:1215–1227CrossRefPubMed

75.

Calfee CS, Delucchi K, Parsons PE, Thompson BT, Ware LB, Matthay MA, NHLBI ARDS Network (2014) Subphenotypes in acute respiratory distress syndrome: latent class analysis of data from two randomised controlled trials. Lancet Respir Med 2:611–620CrossRefPubMedPubMedCentral

76.

Reilly JP, Bellamy S, Shashaty MG, Gallop R, Meyer NJ, Lanken PN, Kaplan S, Holena DN, May AK, Ware LB, Christie JD (2014) Heterogeneous phenotypes of acute respiratory distress syndrome after major trauma. Ann Am Thorac Soc 11:728–736CrossRefPubMedPubMedCentral

77.

Title: Diagnostic workup for ARDS patients
Authors: Laurent Papazian
Carolyn S. Calfee
Davide Chiumello
Charles-Edouard Luyt
Nuala J. Meyer
Hiroshi Sekiguchi
Michael A. Matthay
Gianfranco Umberto Meduri
Publication date: 01-05-2016
Publisher: Springer Berlin Heidelberg
Published in: Intensive Care Medicine / Issue 5/2016
Print ISSN: 0342-4642
Electronic ISSN: 1432-1238
DOI: https://doi.org/10.1007/s00134-016-4324-5

At a glance: The STEP trials

Springer Medicine

Diagnostic workup for ARDS patients

Abstract

At a glance: The STEP trials

Springer Medicine

Abstract

Please log in to get access to this content

Other articles of this Issue 5/2016

Erratum to: The Intensive Care Global Study on Severe Acute Respiratory Infection (IC‑GLOSSARI): a multicenter, multinational, 14-day inception cohort study

Understanding recruitment maneuvers

Does my patient really have ARDS?

Venovenous extracorporeal membrane oxygenation for acute respiratory failure

ARDS in the brain-injured patient: what’s different?

ARDS: what experimental models have taught us