Acute respiratory distress syndrome (ARDS) caused by the novel coronavirus disease (COVID-19): a practical comprehensive literature review

ABSTRACT

Introduction

The exponential growth of SARS-CoV-2 virus transmission during the first months of 2020 has placed substantial pressure on most health systems around the world. The complications derived from the novel coronavirus disease (COVID-19) vary due to comorbidities, sex and age, with more than 50% of the patients requiring some level of intensive care developing acute respiratory distress syndrome (ARDS). The authors carried out an extensive and comprehensive literature review on SARS-CoV-2 infection, the clinical, pathological, and radiological presentation as well as the current treatment strategies.

Areas covered

Various complications caused by SARS-CoV-2 infection have been identified, the most lethal being the acute respiratory distress syndrome, caused most likely by the presence of severe immune cell response and the concomitant alveolus inflammation. The new treatment strategies are updated, and the analysis of the physiopathology is included in this review.

Expert opinion

ARDS is one of the most frequent complications in patients with COVID-19. Information regarding the etiology and physiopathology are still unfolding and for the prevention and amelioration, good clinical management, adequate ventilatory support and the use of systemic corticoids seem to be the most efficient way to reduce mortality and to reduce hospital lengths.

KEYWORDS:

• Acute Respiratory Distress Syndrome
• COVID-19
• expert review
• ARDS
• coronavirus

Article highlights

• There are two types of COVID-19 ARDS response. In the H-type phenotype patients have thickening of the pulmonary tissue, simulating pneumonia and often requiring mechanical ventilation to survive, while the L-type phenotype is characterized by an improved respiratory capacity.

• Chest X-ray, CT Scans or MRI may be normal during the incubation period or throughout the disease, however, in more than 90% of patients with some sort of pulmonary symptomatology, suspected or compatible with COVID-19, the respiratory presentation is characterized by a bilateral radiological alteration.

• In those patients who do not need immediate intubation, they may benefit from supplemental oxygen if SpO2/FiO2> 200, respiratory rate (RR) <25 per minute, and there is no evidence of dyspnea.

• There is no specific pharmacological therapy for COVID-9 but the use of dexamethasone and prone positioning has been shown to decrease mortality and the need of mechanical ventilation, therefore reducing the length of hospital stay.

Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Authors contributions

LU and LM were responsible for the full conceptualization and they were in charge of drafting the document in all of the stages. GP, TM, AR, LT, JCL, FEJ and GDP contributed with the background information and the conceptualization of the proposed guidelines. AMD, EV and DCR completed the second draft of the manuscript while ALC was responsible for the elaboration of the figures and EOP and AL critically review the entire document and reviewed the final version of the manuscript.

Additional information

Funding

This paper was not funded.