In vivo lung perfusion as a platform for organ repair in acute respiratory distress syndrome

Acute respiratory distress syndrome (ARDS) is characterized, according to the most recent Berlin definition, by acute onset of hypoxemia (PaO₂/FiO₂ ≤300) and bilateral pulmonary radiographic opacities, not primarily caused by left heart failure (1). This severe clinical condition culminates from a catastrophic inflammatory response following a direct or indirect acute insult to the lung. A recent global epidemiological investigation showed that there are greater than 3 million ARDS patients per year receiving mechanical ventilation in intensive care units. While intensive care capabilities have advanced significantly, mortality in ARDS patients has not significantly diminished and remains unacceptably high, exceeding 40% in those with the most severe form (2,3). Moreover, survivors have a high risk of experiencing post-traumatic stress disorder and functional deconditioning, which may significantly decrease their quality-of-life (4).