Adult respiratory distress syndrome (ARDS) occurs as a result of severe pulmonary injury that cause alveolar damage heterogeneously throughout the lung 1. It can either result from a direct pulmonary source or as a response to systemic injury.
Lung damage results in leakage of fluid into alveoli, leading to non cardiogenic pulmonary oedema and decreased arterial oxygenation.
The diagnosis is based on mainly clinical criteria set forth by the American-European Consensus Conference 4.
- hypovolaemic shock
- fat embolism
- viral pneumonia
- oxygen toxicity
- smoke inhalalation
- disseminated intravascular coagulopathy
- transfusion reaction
- aspiration of gastric content
- head injury
Chest radiographic findings of ARDS are non specific and resemble those of typical pulmonary oedema or pulmonary haemorrhage : diffuse bilateral coalescent opacities (the only radiologic criterion defined by the Consensus Conference). The time course of ARDS may help in differentiating it from typical pulmonary edema.
Chest x ray features usually develop 12 - 24 hours after initial lung insult.
In contrast to cardiogenic pulmonary oedema, which clears in response to diuretic therapy, ARDS persists for days to weeks. In addition, as the initial radiographic findings of ARDS clear, the underlying lung appears to have a reticular pattern 4.
ARDS carries a high mortality of around 50% 2 and many survivors develop chronic lung disease, with damaged lung healing by fibrosis. A minority recover fully.
- 1. Artigas A, Bernard GR, Carlet J et-al. The American-European Consensus Conference on ARDS, part 2. Ventilatory, pharmacologic, supportive therapy, study design strategies and issues related to recovery and remodeling. Intensive Care Med. 1998;24 (4): 378-98. Intensive Care Med (link) - Pubmed citation
- 2. Artigas, A, Carlet, J, LeGall, JR, et al Clinical presentation, prognostic factors, and outcome of ARDS in the European Collaborative Study (1985–1987): a preliminary report. Zapol, WM Lemaire, F eds. , Adult respiratory distress syndrome (in the series ‘Lung Biology in Health and Disease,’ vol 50, edited by Lenfant C) 1991, 37-63 Marcel Dekker. New York, NY:
- 3. Bernard GR, Artigas A, Brigham KL et-al. Report of the American-European Consensus conference on acute respiratory distress syndrome: definitions, mechanisms, relevant outcomes, and clinical trial coordination. Consensus Committee. J Crit Care. 1994;9 (1): 72-81. Pubmed citation
- 4. Reed JC. Chest radiology, plain film patterns and differential diagnoses. Mosby Elsevier Health Science. (1997) ISBN:0815171226. Read it at Google Books - Find it at Amazon
- 5. Desai SR, Wells AU, Rubens MB et-al. Acute respiratory distress syndrome: CT abnormalities at long-term follow-up. Radiology. 1999;210 (1): 29-35. Radiology (full text) - Pubmed citation
- 6. Marshall R, Bellingan G, Laurent G. The acute respiratory distress syndrome: fibrosis in the fast lane. Thorax. 1998;53 (10): 815-7. Thorax (link) - Free text at pubmed - Pubmed citation
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