Etiology and Multiple Organ System Failure as Prognostic Factors in ARDS

Abstract

The adult respiratory distress syndrome (ARDS) is an acute and severe alteration in lung structure and function characterized by hypoxemia, stiff lungs with low functional residual capacity, and diffuse radiographic infiltrates due to an increased lung capillary permeability [1, 2]. Since first described in 1967 [3], the syndrome has been associated with high mortality and it is disappointing that despite clinical and laboratory investigations survival rates remain virtually unchanged [1]. Patients with the syndrome may die from severity of lung impairment and common complications. It is a conflicting viewpoint whether hypoxemia of acute respiratory failure is the usual cause of death in patients with ARDS. However, supportive measures such as mechanical ventilation with positive end-expiratory pressure (PEEP) [4] or extracorporeal membrane oxygenation [5], although technically successful in increasing arterial oxygenation, have had no obvious effect on reducing mortality. However LFPPV-ECCO₂ R seems promising in selected patients [6]. This suggests a need to focus on the prevention or treatment of other aspects of the syndrome in addition to respiratory supportive measures such as the analysis of the natural history and factors contributing to death.