What is the role of the immune system in the pathogenesis of acute respiratory distress syndrome (ARDS)?

Updated: Mar 27, 2020
  • Author: Eloise M Harman, MD; Chief Editor: Michael R Pinsky, MD, CM, Dr(HC), FCCP, FAPS, MCCM  more...
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Cytokines (tumor necrosis factor [TNF], leukotrienes, macrophage inhibitory factor, and numerous others), along with platelet sequestration and activation, are also important in the development of ARDS. An imbalance of proinflammatory and anti-inflammatory cytokines is thought to occur after an inciting event, such as sepsis. Evidence from animal studies suggests that the development of ARDS may be promoted by the positive airway pressure delivered to the lung by mechanical ventilation. This is termed ventilator-associated lung injury (VALI). Studies (2017) on the ARDSNet patient cohort have identified at least two major subgroups based on immune response and physiologic presentation. [4] Type one reflects primarily acute lung injury without antecedent systemic processes like sepsis or pancreatitis. Type two is acute lung injury with an overwhelming systemic insult like sepsis. Important to note, type one patients benefit from a fluid-restrictive management strategy (infra vide), while type two patients benefit from a fluid-liberal approach. Regrettably, as of now, the prospective early separation of ARDS patients into these two types remains unresolved.


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