Luciano Gattinoni

Abstract: Acute respiratory distress syndrome (ARDS) can originate from either the gas or vascular side of the alveolus. Although the portal for coronavirus disease 2019 (COVID-19) is inhalational, and alveolar infiltrates are commonly found on chest x-ray or computed tomography (CT) scan, the respiratory distress appears to include an important vascular insult that potentially mandates a different treatment approach than customarily applied for ARDS. Indeed, the wide variation in mortality rates across different intensive care units raises the possibility that the approach to ventilatory management could be contributing to outcome.1-3 COVID-19 is a systemic disease that primarily injures the vascular endothelium. If not expertly and individually managed with consideration of the vasocentric features, a COVID-19 patient with ARDS (“CARDS”) may eventually develop multiorgan failure, even when not of advanced age or predisposed by preexisting comorbidity.