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Acute Respiratory Distress Syndrome (ARDS): Causes, Management, and Treatment
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Acute Respiratory Distress Syndrome (ARDS): Causes, Management, and Treatment

A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Respiratory Medicine".

Deadline for manuscript submissions: 25 September 2025 | Viewed by 6026

Special Issue Editors

Dr. Gabriele Sales

E-Mail Website
Guest Editor
Department of Anesthesia, Intensive Care and Emergency, Città Della Salute e Della Scienza di Torino University Hospital, 10126 Turin, Italy
Interests: acute respiratory distress syndrome; mechanical ventilation; intensive care
Dr. Francesca Collino

E-Mail Website
Guest Editor
Department of Anesthesia, Intensive Care and Emergency, Città Della Salute e Della Scienza di Torino University Hospital, 10126 Turin, Italy
Interests: critical care; acute respiratory distress syndrome; mechanical ventilation

Special Issue Information

Dear Colleagues,

Acute respiratory distress syndrome (ARDS) is an acute life-threatening condition resulting from pulmonary causes (e.g., infective, aspiration pneumonia) or extra-pulmonary causes, (e.g., sepsis, trauma, massive transfusion, pancreatitis). Even though ARDS is one of the clinical disorders that occurs in critical care the most frequently, the mortality rate is still remarkably high (40%). From an anatomical point of view, ARDS is associated with capillary endothelial injury and diffuse alveolar damage, resulting in a derangement of blood gas exchange and stiff lungs. Despite the advance in the knowledge of its pathophysiologic mechanisms, ARDS treatment mainly consists of supportive cares—from lung-protective ventilatory strategies and pronation up to extracorporeal membrane oxygenation (ECMO) support—and the management of the underlying causes.

In this Special Issue, we welcome authors to submit papers dealing with the clinical presentation, the assessment and the management of the ARDS in order to better understand its progression and improve the patient’s clinical outcomes.

Dr. Gabriele Sales
Dr. Francesca Collino
Guest Editors

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Journal of Clinical Medicine is an international peer-reviewed open access semimonthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2600 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • acute respiratory distress syndrome
  • mechanical ventilation
  • lung-protective ventilation
  • extracorporeal membrane oxygenation
  • ventilator-induced lung injury
  • hypoxemia
  • rescue therapies
  • pronation
  • lung physiology
  • clinical outcome

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Published Papers (3 papers)

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Research

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15 pages, 3240 KiB  
Article
Therapeutic Effects of TN13 Peptide on Acute Respiratory Distress Syndrome and Sepsis Models In Vivo
by Jae-Eun Byun, Jae-Won Lee, Eun Ji Choi, Juhyun Lee, Seok Han Yun, Chan Ho Park, Hanna Kim, Mi Sun Kim, Suk Ran Yoon, Tae-Don Kim, Ji-Yoon Noh, Sang-Hyun Min, Hyun-A. Seong, Kyung-Seop Ahn, Inpyo Choi and Haiyoung Jung
J. Clin. Med. 2025, 14(6), 1804; https://doi.org/10.3390/jcm14061804 - 7 Mar 2025
Viewed by 582
Abstract
Background/Objectives: Regulation of acute inflammatory responses is crucial for host mortality and morbidity induced by pathogens. The pathogenesis of acute respiratory distress syndrome (ARDS) and sepsis are associated with systemic inflammation. p38 MAPK is a crucial regulator of inflammatory responses and is a [...] Read more.
Background/Objectives: Regulation of acute inflammatory responses is crucial for host mortality and morbidity induced by pathogens. The pathogenesis of acute respiratory distress syndrome (ARDS) and sepsis are associated with systemic inflammation. p38 MAPK is a crucial regulator of inflammatory responses and is a potential target for acute inflammatory diseases, including ARDS and sepsis. We investigated the therapeutic effects of the TAT-TN13 peptide (TN13) on severe inflammatory diseases, including ARDS and sepsis, in vivo. Methods: To establish the ARDS model, C57BL/6 mice were intranasally (i.n.) administered lipopolysaccharide (LPS; 5 mg/kg, 40 µL) to induce lung inflammation. As a positive control, dexamethasone (DEX; 0.2 mg/kg) was administered intraperitoneally (i.n.) 1 h post-LPS exposure. In the experimental groups, TN13 was administered intranasally (i.n.) at doses of 2.5 mg or 5 mg/kg at the same time point. In the LPS-induced sepsis model, mice received an intraperitoneal injection of LPS (20 mg/kg) to induce systemic inflammation. TN13 (25 mg/kg, i.p.) was administered 1 h after LPS treatment. Control mice received phosphate-buffered saline (PBS). Lung histopathology, inflammatory cell infiltration, cytokine levels, and survival rates were assessed to evaluate TN13 efficacy. Results: TN13 significantly reduced inflammatory cell recruitment and cytokine production in the lungs, thereby mitigating LPS-induced ARDS. In the sepsis model, TN13 treatment improved survival rates by suppressing inflammatory responses. Mechanistically, TN13 exerted its effects by inhibiting the p38 MAPK/NF-κB signaling pathway. Conclusions: These results collectively suggested that TN13 could be an effective treatment option for severe inflammatory diseases. Full article
(This article belongs to the Special Issue Acute Respiratory Distress Syndrome (ARDS): Causes, Management, and Treatment)
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15 pages, 1256 KiB  
Article
Outcomes and Impact of Pre-ECMO Clinical Course in Severe COVID-19-Related ARDS Treated with VV-ECMO: Data from an Italian Referral ECMO Center
by Gabriele Sales, Giorgia Montrucchio, Valentina Sanna, Francesca Collino, Vito Fanelli, Claudia Filippini, Umberto Simonetti, Chiara Bonetto, Monica Morscio, Ivo Verderosa, Rosario Urbino and Luca Brazzi
J. Clin. Med. 2024, 13(12), 3545; https://doi.org/10.3390/jcm13123545 - 17 Jun 2024
Viewed by 1385
Abstract
Background: The efficacy of veno-venous extracorporeal membrane oxygenation (VV-ECMO) as rescue therapy for refractory COVID-19-related ARDS (C-ARDS) is still debated. We describe the cohort of C-ARDS patients treated with VV-ECMO at our ECMO center, focusing on factors that may affect in-hospital mortality and [...] Read more.
Background: The efficacy of veno-venous extracorporeal membrane oxygenation (VV-ECMO) as rescue therapy for refractory COVID-19-related ARDS (C-ARDS) is still debated. We describe the cohort of C-ARDS patients treated with VV-ECMO at our ECMO center, focusing on factors that may affect in-hospital mortality and describing the time course of lung mechanics to assess prognosis. Methods: We performed a prospective observational study in the intensive care unit at the “Città della Salute e della Scienza” University Hospital in Turin, Italy, between March 2020 and December 2021. Indications and management of ECMO followed the Extracorporeal Life Support Organization (ELSO) guidelines. Results: The 60-day in-hospital mortality was particularly high (85.4%). Non-survivor patients were more frequently treated with non-invasive ventilatory support and steroids before ECMO (95.1% vs. 57.1%, p = 0.018 and 73.2% vs. 28.6%, p = 0.033, respectively), while hypertension was the only pre-ECMO factor independently associated with in-hospital mortality (HR: 2.06, 95%CI: 1.06–4.00). High rates of bleeding (85.4%) and superinfections (91.7%) were recorded during ECMO, likely affecting the overall length of ECMO (18 days, IQR: 10–24) and the hospital stay (32 days, IQR: 24–47). Static lung compliance was lower in non-survivors (p = 0.031) and differed over time (p = 0.049), decreasing by 48% compared to initial values in non-survivors. Conclusions: Our data suggest the importance of considering NIS among the common ECMO eligibility criteria and changes in lung compliance during ECMO as a prognostic marker. Full article
(This article belongs to the Special Issue Acute Respiratory Distress Syndrome (ARDS): Causes, Management, and Treatment)
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Review

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23 pages, 2410 KiB  
Review
Bedside Assessment of the Respiratory System During Invasive Mechanical Ventilation
by Lorenzo Giosa, Patrick D. Collins, Sridevi Shetty, Marta Lubian, Riccardo Del Signore, Mara Chioccola, Francesca Pugliese and Luigi Camporota
J. Clin. Med. 2024, 13(23), 7456; https://doi.org/10.3390/jcm13237456 - 7 Dec 2024
Viewed by 3201
Abstract
Assessing the respiratory system of a patient receiving mechanical ventilation is complex. We provide an overview of an approach at the bedside underpinned by physiology. We discuss the importance of distinguishing between extensive and intensive ventilatory variables. We outline methods to evaluate both [...] Read more.
Assessing the respiratory system of a patient receiving mechanical ventilation is complex. We provide an overview of an approach at the bedside underpinned by physiology. We discuss the importance of distinguishing between extensive and intensive ventilatory variables. We outline methods to evaluate both passive patients and those making spontaneous respiratory efforts during assisted ventilation. We believe a comprehensive assessment can influence setting mechanical ventilatory support to achieve lung and diaphragm protective ventilation. Full article
(This article belongs to the Special Issue Acute Respiratory Distress Syndrome (ARDS): Causes, Management, and Treatment)
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