[Acute respiratory distress syndrome].
The pathophysiology of acute respiratory distress syndrome (ARDS) is characterized by pulmonary edema due to extravasation from capillary lesions in the endothelium. A clinical diagnosis is made when there is a predisposing cause (sepsis and pneumonia being the most common) that gives rise to acute respiratory insufficiency (PaO2/FiO2 ratio (3/4) 200 mmHg, bilateral infiltrates visible on a chest film and hemodynamic or other clinical signs of left cardiac insufficiency). Most patients require invasive support ventilation at a high FiO2 and positive end-expiratory pressure (PEEP). The only therapeutic approach available at this time associated with a highly significant decrease in mortality in patients with ARDS is ventilation at low flow volumes (6 ml/kg) and moderate levels of PEEP (approximately 10 cmH2O).
Mancebo
J
J
Servicio de Medicina Intensiva. Hospital de la Santa Creu i Sant Pau, Barcelona, Spain. jmancebo@hsp.santpau.es
D001095:Arachidonic Acids / Q000378:metabolism; D019559:Capillary Leak Syndrome / Q000150:complications; D018849:Controlled Clinical Trials as Topic; D016207:Cytokines / Q000378:metabolism; D006801:Humans; D000860:Hypoxia / Q000209:etiology; D015337:Multicenter Studies as Topic; D009504:Neutrophils / Q000378:metabolism; D010100:Oxygen / Q000097:blood; D010313:Partial Pressure; D010743:Phospholipids / Q000378:metabolism; D011014:Pneumonia / Q000150:complications; D011175:Positive-Pressure Respiration; D011187:Posture; D011654:Pulmonary Edema / Q000209:etiology; D012121:Respiration, Artificial; D012128:Respiratory Distress Syndrome / Q000175:diagnosis / Q000209:etiology / Q000401:mortality / Q000503:physiopathology / Q000628:therapy; D015656:Respiratory Mechanics; D018805:Sepsis / Q000150:complications; D019851:Thrombophilia / Q000209:etiology; D018487:Ventricular Dysfunction, Left / Q000209:etiology
D001095:Arachidonic Acids; D016207:Cytokines; D010743:Phospholipids; D010100:Oxygen