Respiratory Mechanics in Ards Patients

Abstract

Although the current definition of adult respiratory distress syndrome (ARDS) was made by Ashbaugh et al. (1), the syndrome was actually described much earlier. A progressive form of pulmonary collapse was known to physicians treating battlefield casualties during World War I (2). As noted by Matthay (3), Osler’s textbook of medicine (4) provides an excellent description of the early phase of the syndrome. In 1927, Osler wrote “uncontrolled septicemia leads to frothy pulmonary edema that resembles serum, not the sanguineous transudative edema fluid seen in dropsy or congestive heart failure.” There were no mechanical ventilators or intensive care units in Osler’s time, so he could not tell us more about ARDS because the development of this type of exudative pulmonary edema was usually a terminal complication. Lung injury following trauma was later described in causalities of World War II as “traumatic wet lung” (5). In this report the authors provided clinical and physiological features of the syndrome and asserted, “It cannot be overemphasized that the lung reacts to trauma just as uniquely as the brain or any highly specialized organ.” In 1950 a pathological state called “congestive atelectasis” was described by Jenkins et al. (6).