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Review
. 2022 Apr;16(4):437-446.
doi: 10.1080/17476348.2022.2057300. Epub 2022 Mar 30.

Understanding the pathophysiology of typical acute respiratory distress syndrome and severe COVID-19

Lorenzo Ball  1   2 , Pedro Leme Silva  3 , Daniele Roberto Giacobbe  4   5 , Matteo Bassetti  4   5 , Gustavo R Zubieta-Calleja  6 , Patricia R M Rocco  3 , Paolo Pelosi  1   2
Affiliations
Review

Understanding the pathophysiology of typical acute respiratory distress syndrome and severe COVID-19

Lorenzo Ball et al. Expert Rev Respir Med. 2022 Apr.

Abstract

Introduction: Typical acute respiratory distress syndrome (ARDS) and severe coronavirus-19 (COVID-19) pneumonia share complex pathophysiology, a high mortality rate, and an unmet need for efficient therapeutics.

Areas covered: This review discusses the current advances in understanding the pathophysiologic mechanisms underlying typical ARDS and severe COVID-19 pneumonia, highlighting specific aspects of COVID-19-related acute hypoxemic respiratory failure that require attention. Two models have been proposed to describe the mechanisms of respiratory failure associated with typical ARDS and severe COVID-19 pneumonia.

Expert opinion: ARDS is defined as a syndrome rather than a distinct pathologic entity. There is great heterogeneity regarding the pathophysiologic, clinical, radiologic, and biological phenotypes in patients with ARDS, challenging clinicians, and scientists to discover new therapies. COVID-19 has been described as a cause of pulmonary ARDS and has reopened many questions regarding the pathophysiology of ARDS itself. COVID-19 lung injury involves direct viral epithelial cell damage and thrombotic and inflammatory reactions. There are some differences between ARDS and COVID-19 lung injury in aspects of aeration distribution, perfusion, and pulmonary vascular responses.

Keywords: ARDS; COVID-19; pathophysiology; perfusion; respiratory failure.

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Figures

Figure 1.
Figure 1.
Evolution of lung damage in COVID-19.
Figure 2.
Figure 2.
Model describing the response to positive end-expiratory pressure (PEEP) and prone positioning in conventional pulmonary and extrapulmonary acute respiratory distress syndrome (ARDS) and in severe COVID-19 pneumonia.
See this image and copyright information in PMC

References

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    2. •• This paper provides a detailed description of the pathophysiological mechanisms of endothelial injury in COVID-19.

    1. Robba C, Battaglini D, Ball L, et al. Distinct phenotypes require distinct respiratory management strategies in severe COVID-19. Respir Physiol Neurobiol. 2020;279:103455. - PMC - PubMed

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