Sequelae of the adult respiratory distress syndrome

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The adult respiratory distress syndrome (ARDS) is characterised by hypoxaemia, bilateral pulmonary infiltrates due to increased permeability, pulmonary oedema and, in most but not all instances, reduced lung compliance. The yearly incidence of ARDS is approximately six per 100 000. ARDS may occur in response to various direct or indirect insults to the lung. Gastric aspiration, bacterial or pneumonia, major trauma, transfusion, and sepsis are among the most common causes (table).'"3 A generally standardised approach to the acute, supportive care of these patients has evolved which uses mechanical ventilation and positive end expiratory pressure (PEEP)4 but, despite increased experience in caring for these critically ill patients, the mortality of patients with ARDS remains at about 50%.56 Death is often due to non-pulmonary causes, multiple organ system failure, or sepsis.7 Patients who survive an episode of ARDS may be asymptomatic and have normal pulmonary function, or they may have marked dyspnoea and severe physiological abnormalities. This editorial will review (1) the functional and physiological abnormalities seen in survivors of ARDS, (2) the predictors ofpulmonary dysfunction in this population, and (3) those aspects of acute patient care which might adversely affect outcome.

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تاریخ انتشار 2004