Role of the coagulation system in ARDS.

268 Role of Coagulation System in ARDS (Hasegawa et a!) T he pathologic findings of the adult respiratory distress syndrome (ARDS) are well described and include lung edema, microthrombi, inflammatory cell infiltration, and late fibrosis.”2 The exact pathogenesis of this syndrome, however, is not well characterized. Considerable evidence from clinical and in vivo investigation implicates neutrophils as important tissue injury mediators in ARDS.3’4 There is also compelling evidence that a variety of mediators, including cytokines, proteases, activated complement system fragments, and arachidonic acid metabolites are important amplifiers of the inflammatory response in ARDS.58 Moreover, impaired host defenses and abnormalities