ARDS is a severe, life-threatening medical condition characterised by widespread inflammation in the lungs and sudden failure of the respiratory system. ARDS causes inflammation of the alveoli in the lungs which are unable to perform the normal oxygenation of blood. It is characterised by rapid breathing, difficulty getting enough air into the lungs and low blood oxygen levels. Common causes of ARDS are sepsis, pneumonia, aspiration of fumes, food or stomach contents going into the lung or significant trauma. The condition was first described in 1967 and gained wide attention during the Vietnam War when it was nicknamed “white lung” as X-rays presented the lungs of the patients as white.
ARDS is the leading cause of respiratory failure in intensive care unit patients requiring mechanical ventilation and oxygen therapy. Despite progress in critical care medicine ARDS is currently associated with a mortality rate of 30 to 45% depending on the severity of the condition. Although ARDS mortality has decreased in the last decade due to improvements in supportive care and in the treatment of the underlying conditions, it still remains high.
Currently, patients suffering from ARDS are generally treated with lung-protective mechanical ventilation. This treatment is accompanied by ancillary support such as positioning, fluid management, and food restrictions. Extra corporeal support may also be provided depending on the severity of the condition. Complications which can also arise whilst a patient is being treated for ARDS include the development of infections, pneumothorax, lung scarring and blood clots which can develop into a pulmonary embolism. Patients who recover from ARDS may suffer other consequences of ARDS after being discharged from the intensive care unit. A recovering patient’s quality of life may be severely adversely affected by permanent damage to the lungs, respiratory problems, scar tissue, muscle weakness and depression.
ARDS is characterised by injury to the endothelial barriers and to the alveolar epithelium of the lung, acute lung inflammation and protein rich pulmonary oedema leading to acute respiratory failure.
The cost of ARDS
ARDS is associated with a long initial ICU stay and hospitalization leading to muscle waisting and cognitive impairment. This causes significant direct costs from the initial hospitalization as well as long term disability and loss in quality of life making it a public health priority. The average length of stay in the ICU because of ARDS is 25 days, and the average length of hospitalization is 47 days. It is estimated that ARDS accounts for 3.6 million hospital days each year in the USA. Over 100,000 patients each year will survive ARDS in the USA and present prolonged morbidity and costs. After a year from surviving the disease only 49% of patients are able to return to work. An average of 13% of ARDS patients will need permanent renal replacement therapy.
Supply of oxygen and nutrients to individual cells of various organs are maintained by vasculature and especially by the long and thin blood vessels called capillaries. Their integrity is sustained by endothelial cells covering the inner surfaces of these vessels and by forming a barrier between circulation and tissues. The breakdown of this barrier results in leakage of blood content to tissues. If this happens in lungs, the lung air space is filled with protein-rich fluid and blood cells preventing the normal gas exchange.
The key molecule to maintain endothelial barrier and lung function is CD73, an endothelial ectoenzyme, which can produce local adenosine. Traumakine’s active pharmaceutical ingredient, interferon beta-1a, increases CD73 expression resulting in increased local adenosine. Subsequently high local adenosine levels reduce capillary leakage and increase lung function by allowing normal gas exchange to return.
Widely used X-ray pictures can reveal lungs filled with blood material. This shows up as white dense material in lung air space and for this reason the lungs of these patients are often called “white lungs”. Typically this picture confirms that the patient has a condition called Acute Respiratory Distress Syndrome and has a life-threatening disease.
Normally functioning lung X-ray shows no “white” material, indicating that lung air space is free of blood material, in contrast to the ARDS lungs above. Long term exposure to a respiratory syndrome like ARDS, can also cause permanent loss of lung capacity due to a fibrotic process that replaces lung alveoli with scar tissue. This serious side effect of ARDS results in permanently reduced respiratory capacity.
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