Hara Yoshitaka

The mortality in patients with acute respiratory distress syndrome (ARDS) remains high (30-40%), although it is showing a downward trend due to the advances in medicine and medical devices. In intensive care, blood purification has been widely used and established as a conventional renal replacement therapy. In Japan, blood purification for the purpose of mediator modulation has recently become widespread. Although there are retrospective reports supporting the effectiveness of polymyxin B-immobilized fiber column direct hemoperfusion (PMX-DHP) for patients with ARDS, when we look at the overall figures, there is little evidence for the effectiveness of blood purification for ARDS. Mediator modulation has become more and more important with the elucidation of the mechanism behind the pathophysiology of ARDS, focusing on the correlation among the major organs, e.g., between lungs and kidneys. In this review, we will focus on the pathophysiology of ARDS, including the association between the lungs and kidneys, and report a systematic review of the literature to assess the effects of blood purification for patients with ARDS.