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Acute respiratory distress syndrome

Acute respiratory distress syndrome (ARDS), also known as respiratory distress syndrome (RDS) or adult respiratory distress syndrome (in contrast with IRDS) is a serious reaction to various forms of injuries to the lung. This is the most important disorder resulting in increased permeability pulmonary edema. more...

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ARDS is a severe lung disease caused by a variety of direct and indirect insults. It is characterized by inflammation of the lung parenchyma leading to impaired gas exchange with concomitant systemic release of inflammatory mediators causing inflammation, hypoxemia and frequently resulting in multiple organ failure. This condition is life threatening and often lethal. So it usually requires mechanical ventilation and admission to an intensive care unit. A less severe form is called acute lung injury (ALI).

ARDS formerly most commonly signified adult respiratory distress syndrome to differentiate it from infant respiratory distress syndrome in premature infants. However, as this type of pulmonary edema also occurs in children, ARDS has gradually shifted to mean acute rather than adult. The differences with the typical infant syndrome remain.

Definition

Historical background

Acute respiratory distress syndrome was first described in 1967 by Ashbaugh et al. Initially there was no definition, resulting in controversy over incidence and mortality. In 1988 an expanded definition was proposed which quantified physiologic respiratory impairment.

In 1994 a new definition was recommended by the American-European Consensus Conference Committee. It had two advantages: 1 it recognizes that severity of pulmonary injury varies, 2 it is simple to use..

ARDS was defined as the ratio of arterial partial oxygen tension (PaO2) as fraction of inspired oxygen (FiO2) below 200 mmHg in the presence of bilateral alveolar infiltrates on the chest x-ray. These infiltrates may appear similar to those of left ventricular failure, but the cardiac silhouette appears normal in ARDS. Also, the pulmonary capillary wedge pressure is normal (less than 18 mmHg) in ARDS, but raised in left ventricular failure.

A PaO2/FiO2 ratio less than 300 mmHg with bilateral infiltrates indicates acute lung injury (ALI). Although formally considered different from ARDS, ALI is usually just a precursor to ARDS.

Consensus after 1967 and 1994

ARDS is characterized by:

  • Acute onset
  • Bilateral infiltrates on chest radiograph
  • Pulmonary artery wedge pressure < 18 mmHg (obtained by pulmonary artery catheterization)
  • if PaO2:FiO2 < 300 acute lung injury (ALI) is considered to be present
  • if PaO2:FiO2 < 200 acute respiratory distress syndrome (ARDS) is considered to be present

Read more at Wikipedia.org


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Prevalence and mortality of acute lung injury and acute respiratory distress syndrome after lung resection
From CHEST, 10/1/05 by Alina Dulu

PURPOSE: To describe the frequency, predictors of mortality and outcome of acute lung injury (ALI) and/or acute respiratory distress syndrome (ARDS) after lung resection.

METHODS: We retrospectively reviewed the case records of all patients who underwent lung resection and developed ALI/ARDS requiring mechanical ventilation and admission to the Intensive Care Unit (ICU) between January 1, 2002 to December 31, 2004. ALI/ARDS were defined according to the American-European Consensus Conference. Perioperative and in-hospital information including ICU-specific data were collected. All patients received supportive treatment for ALI/ARDS including low tidal volume ventilation. Data are presented as mean +/- SD, absolute numbers or percentages. Statistical analyses used were Student's t-test and chi-square tests. P-values < 0.05 were considered significant.

RESULTS: During the study period, 1801 patients underwent lung resection (Table 1). Of these, 50 (2.8%) developed ALI and/or ARDS. The majority of patients (92%) underwent resection for cancer. There were 28 men (56%) and 22 women (44%) with a mean age of 69 [+ or -] 10 years. Eight (16%) received neoadjuvant chemotherapy and 5 (10%) had radiotherapy. The mean postoperative day (POD) to ICU admission was 5 [+ or -] 4 days. The mean ICU LOS was 14.4 [+ or -] 10.6 days and mean hospital LOS was 30.5 [+ or -] 20.2 days. 20 patients (40%) died, 16 in the ICU and 4 after ICU discharge. The mortality rate was highest after pneumonectomy followed by lobectomy and sublobar resections. Older age was associated with higher mortality but not gender, preoperative lung function, use of neoadjuvant therapy, mean POD to ICU admission, glucose and lactate level on ICU admission and paO2/ FiO2 ratio (Table 2).

CONCLUSION: The prevalence rate of ALI/ARDS after lung resection requiting MV and ICU admission was 2.8% with an overall mortality rate of 40%. Mortality was highest after pneumonectomy. Older age correlated with poor outcome.

CLINICAL IMPLICATIONS: Implementation of risk-reduction strategies and advances in ICU support are necessary to reduce the mortality rate associated with ALI/ARDS after lung resection.

DISCLOSURE: Alina Dulu, None.

Alina Dulu MD * Stephen M. Pastores MD Bernard Park MD Neil A. Halpern MD Valerie Rusch MD Memorial Sloan-Kettering Cancer Center, New York, NY

COPYRIGHT 2005 American College of Chest Physicians
COPYRIGHT 2005 Gale Group

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