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ARDS: reaching for the horizon

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More patients die in our intensive care units from Acute Respiratory Distress Syndrome (ARDS; now also including the term Acute Lung Injury) than from any other illness. ARDS constitutes a devastating disease, accounting for 196,600 cases, 74,500 deaths, and 2.2 million ICU days per year for adults, and 7,700 ...

More patients die in our intensive care units from Acute Respiratory Distress Syndrome (ARDS; now also including the term Acute Lung Injury) than from any other illness. ARDS constitutes a devastating disease, accounting for 196,600 cases, 74,500 deaths, and 2.2 million ICU days per year for adults, and 7,700 cases, 1,400 deaths, and 62,000 ICU days per year for children in the US. Inevitably, treatment and complications of ARDS pose a significant burden on our health care budget and the development of new therapeutic strategies represents a major research interest in both adult and pediatric medicine.

Current treatment regimens for ARDS include oxygen supplementation (hyperoxia) and mechanical ventilation, but both modalities have undisputed detrimental effects on lung tissue. Except for the introduction of low tidal volume ventilation, greater awareness of oxygen toxicity and fluid balance, few if any new therapeutic approaches have improved patient survival in the past two decades. Prone positioning has recently regained popularity, while variable results have been reported for surfactant and nitric oxide therapy, as well as for neuromuscular blockade. Steroid therapy is a particularly controversial topic in ARDS management and the use of low-dose glucocorticoid therapy in early ARDS has recently raised attention. Most importantly, large-scale validation of almost all these therapies in children is lacking. Many challenges in managing pediatric ARDS are unique to this population, such as re-emergence of pertussis, enterovirus- and RSV-associated ARDS, role of nutrition in ARDS, the consequences of broncho-pulmonary dysplasia and congenital diaphragmatic hernia on subsequent ARDS, stem cell therapy applied to an immature immune system, ARDS pathophysiology in pediatric oncology patients, the emergence of new invasive and non-invasive modalities of pediatric respiratory support, and ultimately pediatric ARDS outcomes.

We propose to collect 20 state-of–the-art manuscripts from international experts in the field of pediatric ARDS. The completed e-book will cover ARDS topics including, but not limited to, an updated definition of pediatric ARDS; pediatric ARDS biomarkers; an update on the most relevant current ARDS etiologies; pediatric lung injury and repair mechanisms; past, current and future ARDS therapies, ranging from non-invasive devices to modern ECMO therapy; pediatric ARDS short- and long-term outcomes; and a view into the future of pediatric ARDS research.

This e-book will constitute the first, comprehensive resource on pediatric ARDS in the 21st century for both the general practitioner as well as for pulmonary and critical care specialists, critical care nurses and respiratory therapists.


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