Journal article

Publication year: 2021

Journal: European Respiratory Review

Volume number: 30

Issue number: 161

ISSN: 0905-9180

eISSN: 1600-0617

Open access status: Gold

DOI Link: https://doi.org/10.1183/16000617.0059-2021

Publisher: European Respiratory Society

Abstract: 
Acute respiratory distress syndrome (ARDS) is a serious complication of severe systemic or local pulmonary inflammation, such as caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. ARDS is characterised by diffuse alveolar damage that leads to protein-rich pulmonary oedema, local alveolar hypoventilation and atelectasis. Inadequate perfusion of these areas is the main cause of hypoxaemia in ARDS. High perfusion in relation to ventilation (V/Q<1) and shunting (V/Q=0) is not only caused by impaired hypoxic pulmonary vasoconstriction but also redistribution of perfusion from obstructed lung vessels. Rebalancing the pulmonary vascular tone is a therapeutic challenge. Previous clinical trials on inhaled vasodilators (nitric oxide and prostacyclin) to enhance perfusion to high V/Q areas showed beneficial effects on hypoxaemia but not on mortality. However, specific patient populations with pulmonary hypertension may profit from treatment with inhaled vasodilators. Novel treatment targets to decrease perfusion in low V/Q areas include epoxyeicosatrienoic acids and specific leukotriene receptors. Still, lung protective ventilation and prone positioning arc the best available standard of care. This review focuses on disturbed perfusion in ARDS and aims to provide basic scientists and clinicians with an overview of the vascular alterations and mechanisms of V/Q mismatch, current therapeutic strategies, and experimental approaches.

Harvard Citation style: Gierhardt, M., Pak, O., Walmrath, D., Seeger, W., Grimminger, F., Ghofrani, H., et al. (2021) Impairment of hypoxic pulmonary vasoconstriction in acute respiratory distress syndrome, European Respiratory Review, 30(161), Article 210059. https://doi.org/10.1183/16000617.0059-2021

APA Citation style: Gierhardt, M., Pak, O., Walmrath, D., Seeger, W., Grimminger, F., Ghofrani, H., Weissmann, N., Hecker, M., & Sommer, N. (2021). Impairment of hypoxic pulmonary vasoconstriction in acute respiratory distress syndrome. European Respiratory Review. 30(161), Article 210059. https://doi.org/10.1183/16000617.0059-2021