New insights in ARDS pathogenesis
1Foundation for Biomedical Research of the Getafe University Hospital, 28905 Getafe, Madrid, Spain
2Department of Critical Care Medicine, Getafe University Hospital, 28905 Getafe, Madrid, Spain
3CIBER of respiratory diseases (CIBERES), Carlos III Health Institute, 28029 Madrid, Spain
4Department of Clinical Analysis, Getafe University Hospital, 28905 Getafe, Madrid, Spain
5Clinical Department, European University of Madrid, 28670 Villaviciosa de Odón, Madrid, Spain
6Department of Bioengineering, Carlos III University, 28911 Leganés, Madrid, Spain
DOI: 10.22514/sv.2022.058 Vol.18,Issue 5,September 2022 pp.51-67
Submitted: 15 March 2022 Accepted: 06 July 2022
Published: 08 September 2022
Acute respiratory distress syndrome (ARDS) is a life-threatening condition in critically ill patients characterized by hypoxemia and non-compliant lung. In this review, we discuss the pathophysiology of ARDS, including the mechanisms involved in the formation of pulmonary edema, the dysregulated inflammatory and immune responses, the activation of procoagulant events, the cellular communication by extracellular vesicles (EVs) between different types of cells and the interaction of the lung with other organs. Activation of inflammation, coagulation, and cell death processes result in the disruption of the alveolar-capillary membrane and the consequent protein-rich edema formation in the alveoli, in which structural and functional alterations of the alveolar epithelium play an essential role. Inflammation and activated endothelial cells trigger coagulation cascades and platelets that generate a procoagulant state in both the airspace and the intravascular compartment with the formation of fibrin in airspaces and thrombi in the microvasculature that aggravate alveolar injury and gas exchange. The crosstalk between epithelial/endothelial cells, platelets, and immune cells is mediated by EVs, whose role in the pathogenesis of ARDS is not known. Finally, the interaction of the lung with other organs has become an important determinant in the development and resolution of ARDS. Understanding the pathophysiological mechanisms involved in ARDS is crucial to developing new therapeutic strategies.
Acute respiratory distress syndrome; Mechanisms; Pulmonary edema; Inflammation; Coagulation; Extracellular vesicles (EVs); Organ interaction
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