Elsevier

Medicina Intensiva

Volume 40, Issue 3, April 2016, Pages 169-175
Medicina Intensiva

REVISIÓN
Distrés respiratorio agudo: del síndrome a la enfermedadAcute Respiratory Distress: from syndrome to disease

https://doi.org/10.1016/j.medin.2015.11.006Get rights and content

Resumen

El síndrome de distrés respiratorio agudo (SDRA) constituye una de las entidades más importantes de la medicina crítica dada su elevada incidencia, mortalidad, secuelas a largo plazo y ausencia de un tratamiento farmacológico específico.

El patrón histológico característico del SDRA es el daño alveolar difuso (DAD). Aproximadamente el 50% de los pacientes con SDRA tienen DAD; el resto está constituido por un grupo heterogéneo de patrones histológicos, muchos de los cuales constituyen enfermedades bien caracterizadas que, de ser diagnosticadas, podrían beneficiarse de un tratamiento específico.

Recientemente se ha demostrado el efecto del DAD en la evolución clínica y analítica del SDRA, por lo cual, el enfoque clásico del SDRA como una entidad definida exclusivamente por variables clínicas, radiológicas y gasométricas podría ser reconsiderado.

La presente revisión narrativa procura analizar la necesidad de evolucionar desde el concepto de SDRA como síndrome a SDRA como enfermedad; para ello hemos planteado 4 preguntas que consideramos prioritarias: a) ¿qué es una enfermedad?; b) ¿qué es el DAD?; c) ¿cómo consideran al DAD las distintas definiciones de SDRA?, y d) ¿qué relación existe entre el DAD y el SDRA?

Abstract

The acute respiratory distress syndrome (ARDS) is currently one of the most important critical entities given its high incidence, rate of mortality, long-term sequelae and non-specific pharmacological treatment.

The histological hallmark of ARDS is diffuse alveolar damage (DAD). Approximately 50% of ARDS patients present DAD, the rest is made up of a heterogeneous group of histological patterns, many of which correspond to a well-recognized disease. For that reason, if these patterns could be diagnosed, patients could benefit from a treatment.

Recently, the effect of DAD in clinical and analytical evolution of ARDS has been demonstrated, so the classical approach to ARDS as an entity defined solely by clinical, radiological and gasometrical variables should be reconsidered.

This narrative review aims to examine the need to evolve from the concept of ARDS as a syndrome to ARDS as a specific disease. So we have raised 4 critical questions: a) What is a disease?; b) what is DAD?; c) how is DAD considered according to ARDS definition?, and d) what is the relationship between ARDS and DAD?

Section snippets

¿Qué es una enfermedad?

Los algoritmos diagnósticos son las herramientas que utiliza el clínico para transitar racionalmente desde los síntomas y signos por los cuales el paciente consulta (agrupados habitualmente en síndromes) hasta el diagnóstico de una enfermedad específica, que se pueda beneficiar de un tratamiento dirigido23. Posiblemente una de las palabras más frecuentemente utilizadas en medicina sea «enfermedad»; a pesar de lo familiar que nos pueda resultar este término, definirlo constituye un gran reto24.

Financiación

El presente manuscrito no tuvo ningún tipo de financiación.

Conflicto de intereses

Los autores declaran no tener ningún conflicto de interés.

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