The Adult Respiratory Distress Syndrome: Mechanisms and Management

  • Guy A. Zimmerman
Chapter
Part of the Developments in Critical Care Medicine and Anaesthesiology book series (DCCA, volume 9)

Abstract

The term “adult respiratory distress syndrome”, abbreviated ARDS, was coined less than 20 years ago to describe adult patients with a specific form of acute respiratory failure (1). As implied by the name, ARDS is a syndrome characterized by a group of clinical and pathophysiologic features which indicate severe lung injury that results from a variety of underlying disease processes. The key pathophysiologic feature that differentiates ARDS from other forms of acute respiratory failure in adults is diffuse injury to the alveolar capillary membrane (2). The injury can result from insults delivered via the airway (as in gastric acid aspiration or diffuse bacterial pneumonia), via the bloodstream (as in ARDS associated with gram negative bacteremia, or endotoxemia, resulting from an infectious focus distant from the lung), or via both routes. There is no single clinical feature that defines the syndrome of ARDS. Furthermore, a laboratory test that identifies diffuse alveolar capillary injury, and differentiates it from other disease processes, does not exist. Therefore the syndrome is recognized by a constellation of clinical and pathophysiologic findings (1,3) (Table 1). Each of the features listed in Table 1 can occur in association with other causes of acute respiratory failure, but together they define the clinical syndrome of ARDS. In addition to the classic findings listed in Table 1, pulmonary hypertension is a common feature in patients with this syndrome (16,17).

Keywords

Lung Injury Acute Respiratory Failure Adult Respiratory Distress Syndrome Underlying Disease Process Clin Chest 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.
This is a preview of subscription content, log in to check access.

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. 1.
    Ashbaugh DG et al. Acute respiratory distress in adults. Lancet 2: 319, 1967.PubMedCrossRefGoogle Scholar
  2. 2.
    Murray JF. Conference report: Mechanisms of acute respiratory failure. Am Rev Resp Dis 115: 1071, 1977.Google Scholar
  3. 3.
    Petty TH. Adult respiratory distress syndrome. Sem Resp Med 2: 99, 1981.CrossRefGoogle Scholar
  4. 4.
    Petty TL. Adult respiratory distress syndrome: Definition and historical perspective. Clin Chest Med 3: 3, 1982.PubMedGoogle Scholar
  5. 5.
    Hopewell PC, Murray JF. The adult respiratory distress syndrome. Ann Rev Med 27: 343, 1976.PubMedCrossRefGoogle Scholar
  6. 6.
    Bone RC, editor. The adult respiratory distress syndrome. Clin Chest Med 3:1–215, 1982.Google Scholar
  7. 7.
    Fowler AA et al. Adult respiratory distress syndrome: Risk with common predispositions. Ann Int Med 98: 593, 1983.PubMedGoogle Scholar
  8. 8.
    Pepe PE et al. Clinical predictors of the adult respiratory distress syndrome. Am J Surg 144: 124, 1982.PubMedCrossRefGoogle Scholar
  9. 9.
    Rinaldo JE, Rogers RM. Adult respiratory distress syndrome. Changing concepts of lung injury and repair. N Eng J Med 206: 900, 1982.CrossRefGoogle Scholar
  10. 10.
    Bachofen M, Weibel ER. Structural alterations of lung parenchyma in the adult respiratory distress syndrome. Clin Chest Med 3: 35, 1982.PubMedGoogle Scholar
  11. 11.
    Anderson RR et al. Documentation of pulmonary capillary permeability in the adult respiratory distress syndrome accompanying human sepsis. Am Rev Resp Dis 119: 869, 1979.PubMedGoogle Scholar
  12. 12.
    Albert RK. Factors affecting transvascular fluid and protein movement in pulmonary edema and ARDS. Sem Resp Med 2: 102, 1981.CrossRefGoogle Scholar
  13. 13.
    Staub NC. The pathogenesis of pulmonary edema. Prog Cardiovasc Dis 23: 53, 1980.PubMedCrossRefGoogle Scholar
  14. 14.
    Greene R et al. Early bedside detection of pulmonary vascular occlusion during acute respiratory failure. Am Rev Resp Dis 124: 593, 1981.PubMedGoogle Scholar
  15. 15.
    Elliott CG et al. Granulocyte aggregation in adult respiratory distress syndrome (ARDS): Serial histologic and physiologic observations. Am J Med Sci: In Press, September, 1984.Google Scholar
  16. 16.
    Zapol WM, Snider MT. Pulmonary hypertension in severe acute respiratory failure. N Eng J Med 296: 476, 1977.CrossRefGoogle Scholar
  17. 17.
    Zimmerman GA et al. Cardiovascular alterations in the adult respiratory distress syndrome. Am J Med 73: 25, 1982.PubMedCrossRefGoogle Scholar
  18. 18.
    Zimmerman GA et al. Functional and metabolic activity of granulocytes from patients with adult respiratory distress syndrome: evidence for activated neutrophils in the pulmonary circulation. Am Rev Resp Dis 127: 290, 1983.PubMedGoogle Scholar
  19. 19.
    Snow RL et al. Pulmonary vascular remodeling in adult respiratory distress syndrome. Am Rev Resp Dis 126: 887, 1982.PubMedGoogle Scholar
  20. 20.
    Staub NC. Pulmonary edema. Physiologic approaches to management. Chest 74: 559, 1978.PubMedCrossRefGoogle Scholar
  21. 21.
    Brigham K et al. Increased sheep lung vascular permeability caused by E. Coli endotoxin. Circ Res 45: 292, 1979.PubMedGoogle Scholar
  22. 22.
    Hallman M et al. Evidence of lung surfactant abnormality in respiratory failure. J Clin Invest 70: 673, 1982.PubMedCrossRefGoogle Scholar
  23. 23.
    Pingleton SK. Complications associated with the adult respiratory distress syndrome. Clin Chest Med 3: 143, 1982.PubMedGoogle Scholar
  24. 24.
    Bell RC et al. Multiple organ system failure and infection in adult respiratory distress syndrome. Ann Int Med 99: 293, 1983.PubMedGoogle Scholar
  25. 25.
    Hudson LD. Causes of the adult respiratory distress syndrome: Clinical recognition. Clin Chest Med 3: 195, 1982.PubMedGoogle Scholar
  26. 26.
    Wiedmann HP et al. Cardiovascular-pulmonary monitoring in the intensive care unit. Chest 85: 537, 1984.CrossRefGoogle Scholar
  27. 27.
    Morris AH . Clinical application of the Fick Equation. Pulmonary Fellow’s Handbook, Intermountain Respiratory Intensive Care Unit, LDS Hospital, Salt Lake City, Utah, 1976.Google Scholar
  28. 28.
    Petty TL, Ashbaugh DG. The adult respiratory distress syndrome. Clinical features, factors influencing prognosis, and principles of management. Chest 60: 233, 1971.PubMedCrossRefGoogle Scholar
  29. 29.
    Gong H. Positive-pressure ventilation in the adult respiratory distress syndrome. Clin Chest Med 3: 69, 1982.PubMedGoogle Scholar
  30. 30.
    Weisman IM et al. Positive end-expiratory pressure in adult respiratory failure. N Eng J Med 307: 1381, 1982.CrossRefGoogle Scholar
  31. 31.
    Tyler DC. Positive end expiratory pressure: A review. Crit Care Med 11: 300, 1983.PubMedCrossRefGoogle Scholar
  32. 32.
    Rizk NW, Murray J. PEEP and pulmonary edema. Am J Med 72: 381, 1982.PubMedCrossRefGoogle Scholar
  33. 33.
    Luce J et al. The effects of expiratory positive airway pressure on the resolution of oleic acid-induced lung injury in dogs. Am Rev Resp Dis 125: 716, 1982.PubMedGoogle Scholar
  34. 34.
    Hudson LD. Adult respiratory distress syndrome. In RM Cherniack (editor),Current Therapy of Respiratory Disease 1984-1985. BC Decker, Inc, Philadelphia, 1984, PP 284.Google Scholar
  35. 35.
    Prewitt RM et al. Treatment of acute low pressure pulmonary edema in dogs. Relative effects of hydrostatic and oncotic pressure, nitroprusside, and positive end expiratory pressure. J Clin Invest 67: 409, 1981.PubMedCrossRefGoogle Scholar
  36. 36.
    Wood LDH, Prewitt RM. Cardiovascular management in acute hypoxemic respiratory failure. Am J Card 47: 963, 1981.PubMedCrossRefGoogle Scholar
  37. 37.
    Ghingnone M et al. Effects of hydralazine on cardiopulmonary function in canine low-pressure pulmonary edema. Anesthesiol 59: 187, 1983.Google Scholar
  38. 38.
    Matamis D et al. Redistribution of pulmonary blood flow induced by positive end expiratory pressure and dopamine infusion in acute respiratory failure. Am Rev Resp Dis 129: 39, 1984.PubMedGoogle Scholar
  39. 39.
    Nanjo S et al. Concentrated albumin does not affect lung edema formation after acid instillation in the dog. Am Rev Resp Dis 126: 884, 1983.Google Scholar
  40. 40.
    Prewitt RM, Ghingnone M. Treatment of right ventricular dysfunction in acute respiratory failure. Crit Care Med 11: 346, 1983.PubMedCrossRefGoogle Scholar
  41. 41.
    Nicholson DP. Glucocorticoids in the treatment of shock and the adult respiratory distress syndrome. Clin Chest Med 3: 121, 1982.PubMedGoogle Scholar
  42. 42.
    Pepe PE et al. Early application of PEEP in patients at risk for ARDS. Am Rev Resp Dis 127: 97A, 1983.Google Scholar
  43. 43.
    Pontoppidan H et al. Respiratory intensive care. Anesthesiol 47: 96, 1977.CrossRefGoogle Scholar
  44. 44.
    Sibbald WJ et al. Alveolar-capillary permeability in human septic ARDS. Effect of high-dose corticosteroid therapy. Chest 79: 133, 1981.PubMedCrossRefGoogle Scholar
  45. 45.
    Fein AM et al. The risk factors, incidence, and prognosis of ARDS following septicemia. Chest 83: 40, 1983.PubMedCrossRefGoogle Scholar
  46. 46.
    Clemmer TP, Orme JF. Nutritional support in the adult respiratory distress syndrome. Clin Chest Med 3: 101, 1982.PubMedGoogle Scholar
  47. 47.
    Fourrier F et al. Angiotensin converting enzyme in human adult respiratory distress syndrome. Chest 83: 593, 1983.PubMedCrossRefGoogle Scholar
  48. 48.
    Carvalho A et al. Altered factor VIII in acute respiratory failure. N Eng J Med 307: 1113, 1982.CrossRefGoogle Scholar
  49. 49.
    Repine JE (editor). Lung defense, injury and repair. Chest 83:(Supplement):1 S-103 S, 1983.CrossRefGoogle Scholar
  50. 50.
    Hammerschmidt DE et al. Association of complement activation and elevated plasma-C5a with adult respiratory distress syndrome. Pathophysiologic relevance and possible prognostic value. Lancet 1: 947, 1980.PubMedCrossRefGoogle Scholar
  51. 51.
    Zimmerman GA et al. Granulocyte adherence in pulmonary and systemic arterial blood samples from patients with adult respiratory distress syndrome. Am Rev Resp Dis 129: 798, 1984.PubMedGoogle Scholar
  52. 52.
    Schneider RC et al. Platelet consumption and sequestration in severe acute respiratory failure. Am Rev Resp Dis 122: 445, 1980.PubMedGoogle Scholar
  53. 53.
    Haynes JB et al. Elevated fibrinogen degradation products in the adult respiratory distress syndrome. Am Rev Resp Dis 122: 841, 1980.PubMedGoogle Scholar
  54. 54.
    Cochran CG et al. The presence of neutrophil elastase and evidence of oxidation activity in bronchoalveolar lavage fluid of patients with adult respiratory distress syndrome. Am Rev Resp Dis 127:S25- S27, 1983.Google Scholar
  55. 55.
    Chand N, Altura BM. Acetylcholine and bradykinin relax intrapulmonary arteries by acting on endothelial cells: Role in lung vascular diseases. Science 213: 1376, 1981.PubMedCrossRefGoogle Scholar
  56. 56.
    Sprung CL et al. Effects of corticosteroids on the incidence of the adult respiratory distress syndrome (ARDS) in patients with septic shock: A prospective study. Am Rev Resp Dis 129:Al02, 1984.Google Scholar
  57. 57.
    Ogletree ML, Brigham KL. PGE1 reduces lung transvascular filtration during endotoxin-induced high permeability in sheep. Clin Res 27: 402A, 1979.Google Scholar
  58. 58.
    Appel PL, Shoemaker WC. Effect of prostaglandin (E1) on hemodynamic and oxygen transport in ARDS. Crit Care Med 11: 242, 1983.Google Scholar
  59. 59.
    Zapol WM et al. L-3,4-dehydroproline suppression of fibrosis in ARDS: Early clinical results. Am Rev Resp Dis 1984: 129, A102.Google Scholar

Copyright information

© Martinus Nijhoff Publishers, Dordrecht 1985

Authors and Affiliations

  • Guy A. Zimmerman

There are no affiliations available

Personalised recommendations