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Review
. 2021 Oct;37(4):717-732.
doi: 10.1016/j.ccc.2021.05.002.

Environmental Factors

Katherine D Wick  1 , Michael A Matthay  2
Affiliations
Review

Environmental Factors

Katherine D Wick et al. Crit Care Clin. 2021 Oct.

Abstract

The acute respiratory distress syndrome (ARDS) remains a major cause of morbidity and mortality in the intensive care unit. Improving outcomes depends on not only evidence-based care once ARDS has already developed but also preventing ARDS incidence. Several environmental exposures have now been shown to increase the risk of ARDS and related adverse outcomes. How environmental factors impact the risk of developing ARDS is a growing and important field of research that should inform the care of individual patients as well as public health policy.

Keywords: Acute lung injury (ALI); Acute respiratory distress syndrome (ARDS); Environmental pollution; Tobacco smoke; Wildfires; e-cigarette and vaping-associated lung injury (EVALI); e-cigarettes.

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Conflict of interest statement

Disclosure K.D. Wick: Grant funding from NIH (5T32GM008440–24). M.A. Matthay: Grant funding from NIH (HL123004, HL134828, and HL140026). Income from Citius Pharmaceuticals and research support from Genentech-Roche for observational studies of ARDS.

Figures

Fig. 1
Fig. 1
Levels of intervention to prevent adverse outcomes from ARDS.
Fig. 2
Fig. 2
Changes in ambient levels of major pollutants in the United States, 2008 to 2018. Dotted lines represent 95% confidence intervals.
Fig. 3
Fig. 3
Pollution and/or cigarette smoke exposure likely predisposes the lung to severe injury in the presence of risk factors for ARDS such as trauma, sepsis, or multiple transfusions.
Fig. 4
Fig. 4
Computed tomographic scan of a patient with EVALI, demonstrating diffuse bilateral ground glass opacities with characteristic subpleural sparing.
See this image and copyright information in PMC

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