Mechanistic hypothesis: promotes fibrosis if given during proliferative phase
VV-ECMO evidence
CESAR trial (2009)
Transfer to ECMO center improved survival without severe disability: 63% vs. 47%
Confounded by better overall care at ECMO centers
EOLIA trial (2018)
No statistically significant mortality benefit in primary endpoint
Crossover rescue ECMO reduced 60-day mortality in severe ARDS
Current practice: VV-ECMO at ECMO-capable centers for PaO2/FiO2 < 80 mmHg refractory cases
Patient Discharge Instructions
copy discharge instructions
Discharge instructions for non-cardiogenic pulmonary edema
What happened
You were treated for a serious lung condition called non-cardiogenic pulmonary edema
This occurs when fluid leaks into the lungs due to injury or illness, not a heart problem
Your oxygen levels were low and your lungs needed support to recover
Medications
Take all prescribed medications exactly as directed
Do not stop any antibiotics or steroids early even if feeling better
Ask your pharmacist or doctor before starting any new medications including over-the-counter drugs
Activity
Rest and limit strenuous activity for at least 2 weeks after discharge
Shortness of breath with exertion is expected; increase activity gradually
Pulmonary rehabilitation referral provided or to be arranged at follow-up
Breathing
Use supplemental oxygen at home as prescribed; do not adjust flow rate without medical guidance
Practice incentive spirometry 10 times per hour while awake to prevent lung collapse
Sleep with head of bed elevated 30-45 degrees if breathing is uncomfortable lying flat
Follow-up appointments
Primary care physician within 1-2 weeks of discharge
Pulmonology or ICU recovery clinic at 1-3 months post-discharge
Lung function tests (spirometry, DLCO) at 3-6 months
Return to emergency department immediately if
Worsening or sudden shortness of breath
Oxygen level (SpO2) < 92% on home pulse oximeter
Chest pain or pressure
Coughing up blood
New confusion, difficulty thinking clearly, or unusual behavior
Fever > 38.5 C (101.3 F)
Inability to perform daily activities without severe breathlessness
Long-term recovery expectations
Most lung recovery occurs in the first 6-12 months
Some people have lasting effects including fatigue, weakness, or mood changes
Post-intensive care syndrome (PICS) is common: affects physical, cognitive, and mental health
Screening for depression, anxiety, and PTSD will occur at follow-up visits
Lifestyle
Do not smoke; smoking worsens lung recovery and increases risk of future lung complications
Avoid alcohol or substances that may have contributed to the hospitalization
Stay well hydrated and maintain adequate nutrition for recovery
If altitude exposure triggered this event, avoid high altitude until cleared by a physician
References
Guidelines and key sources
Gorman EA, O'Kane CM, McAuley DF. Acute Respiratory Distress Syndrome in Adults: Diagnosis, Outcomes, Long-Term Sequelae, and Management. Lancet. 2022
PMID 36070788
Comprehensive review of ARDS epidemiology, management, and long-term outcomes
Qadir N, Sahetya S, Munshi L, et al. An Update on Management of Adult Patients With Acute Respiratory Distress Syndrome: An Official American Thoracic Society Clinical Practice Guideline. Am J Respir Crit Care Med. 2024
PMID: PMC10870893
Current ATS clinical practice guideline for ARDS management
Bos LDJ, Ware LB. Acute Respiratory Distress Syndrome: Causes, Pathophysiology, and Phenotypes. Lancet. 2022
PMID 36070787
Pathophysiology and phenotypic classification of ARDS
Ware LB, Matthay MA. Acute Pulmonary Edema. N Engl J Med. 2005
DOI: 10.1056/NEJMcp052699
Stepwise approach differentiating cardiogenic from non-cardiogenic pulmonary edema
Fan E, Brodie D, Slutsky AS. Acute Respiratory Distress Syndrome: Advances in Diagnosis and Treatment. JAMA. 2018
DOI: 10.1001/jama.2017.21907
Landmark JAMA review of diagnosis and treatment evidence
Comprehensive primer on ARDS biology and clinical management
SymptomDx is an educational tool for medical professionals. It does not replace clinical judgment. Verify all clinical data and drug dosages with authoritative sources.