The Open Respiratory Medicine Journal, 2015, 9, (Suppl 2: M1) 81-82 81
Open Access
Editorial
Acute Respiratory Failure: Pathophysiological Basis From A
Multidisciplinary Clinical Approach
Rodrigo L. Castillo*,§
Programa de Fisiopatología, Instituto de Ciencias Biomédicas, Facultad de Medicina, Universidad de Chile, Chile
INTRODUCTION TO SPECIAL ISSUE Pathophysiological Perspectives in Acute Respiratory
Failure
Acute Respiratory Failure: Pathophysiological Basis
from a Multidisciplinary Clinical Approach The pathophysiological basis of ALI/ARDS involved an
activation and modulation of various inflammatory and
Acute Respiratory Failure (ARF) is a syndrome inmune events. three themes are updated: ALI/ARS
characterized by the inability of the respiratory system to pathophysiology, the current concepts of transfusion-related
maintain adequate arterial O2 and CO2 levels according to acute lung injury (TRALI) and ventilatory induced lung
the demands of cellular metabolism. ARF may be caused by injury (VILI). In the first review, the authors detailed the role
the failure of the exchanger, lung, organ or pump, or failure of host in the evolution of lung inflammation to ALI/ARDS
of the respiratory muscles. ARF can be classified by the [3]. Indeed, relevant information is described respect to each
dysfunctional element or the evolution time when the animal model, reproducing key components of the injury and
condition occurs. resolution phases of human ALI/ARDS, and provide a
Acute lung injury/acute respiratory distress syndrome methodology to explore mechanisms and potential new
(ALI/ARDS) is the most important cause of adults therapies.
hipoxemic respiratory failure, which results from multiple In the manuscript about current concepts of TRALI,
clinical factors such as sepsis or trauma [1]. Although the Alvarez et al., provided a general view of mechanisms that
main cause was clinically resolved, the mechanism that lead to the development of this syndrome: immune-mediated
determines the progression may persist and lead to and no immune- mediated TRALI. Indeed, the experimental
complications. TRALI models are focused in the importance of neutrophils
However, It is demonstrated that the clinical causes of in mediating the early immune response, and lung vascular
respiratory failure increase the intensive care units (ICU) injury [4].
stay, the sanitary cost and the global mortality [2]. For this In the review of VILI in ARDS, Carrasco et al.,
reason, multidisciplinary and pathophysiological focus on described in detail an approach to VILI focused on the
respiratory failure is necessary for the management of these effects of volutrauma that lead to lung injury and the
patients. ‘mechanotransduction’ mechanism. A more complete
The application of non-invasive mechanical ventilation understanding about the molecular effects that physical
(NIMV) has acquired major relevance in the last few years in forces could have, is essential for a better assessment of
the management of ARF, in patients with hypoxemic and existing strategies as well as the development of new
hypercapnic failure. The main advantage of NIMV compared therapeutic strategies to reduce the damage resulting from
to invasive mechanical ventilation is that it can be used VILI.
earlier outside ICU. The evidence strongly supports its use in
patients with chronic obstructive pulmonary disease (COPD) Use of Noninvasive/Invasive Mechanical Ventilation with
exacerbation, patients with acute cardiogenic pulmonary Pathophysiological Approaches
edema and immunosuppressed patients.
In the review of Romero-Dapueto et al., is presented the
This issue is focused on the mechanism associated with evidence for the use of NIMV in patients with COPD
ARF, some clinical syndromes, and the pathophysiological exacerbation, patients with acute cardiogenic pulmonary
bases for the use of ventilatory strategies, with a edema, and Immunosuppressed patients [5]. Indeed, the
multidisciplinary approach. pathophysiological evidence that supports the use of NIMV
in other pathologies such as pneumonia, ARDS, and during
procedures as bronchoscopy. In the last case, its use is still
*Address correspondence to this author at the Programa de Fisiopatología, controversial because the results of these studies are
Instituto de Ciencias Biomédicas, Facultad de Medicina, Universidad de inconclusive against the decrease in the rate of intubation or
Chile. Independencia 1027, 8380453, Santiago, Chile;
Tel/Fax: 56-2-9786943, E-mail: rcastillo@med.uchile.cl
mortality.
§
Guest Editor
1874-3064/15 2015 Bentham Open
82 The Open Respiratory Medicine Journal, 2015, Volume 9 Editorial
In the review of Cerpa et al., is described that the Reviewers included: Farías JG, Sotomayor R, Zepeda R and
humidification of the airway is required in all patients with Noriega V.
artificial airway and/or connected to invasive mechanical
I hope that you will find this special issue helpful and
ventilation. Humidification devices can be Hygroscopy Heat
interesting.
or Heat and Moisture Exchangers, being the clinical
characteristics the ones that determine which device should
be chosen [6]. Indeed, It is important to select the right REFERENCES
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© Rodrigo L. Castillo; Licensee Bentham Open.
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