Hemodynamic monitoring in patients with acute respiratory distress syndrome

Abstract

Acute respiratory distress syndrome (ARDS) is due to the increase in permeability of the capillary alveolar membrane leading to non-cardiogenic pulmonary edema and hypoxia. Because ARDS is often associated with shock, its mortality rate remains high. One of the difficulties in ARDS is the management of fluid and volume expansion. During shock, volume expansion may lead to increase in oxygen transport related to increase in cardiac output, thus improving the patient’s outcome. However, in case of ARDS, pulmonary capillary leakage could raise hypoxia and lead to decrease in oxygen transport during volume expansion. Therefore, hemodynamic monitoring is mandatory in ARDS. Monitoring allows analyzing the right ventricular function and pulmonary capillary leakage, helping to predict fluid responsiveness and risk of increased pulmonary edema. In ARDS, monitoring should be based on oxygen transport that would take into account all hemodynamic and respiratory parameters.