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Semin Respir Crit Care Med 2001; 22(3): 259-268
DOI: 10.1055/s-2001-15783
Copyright © 2001 by Thieme Medical Publishers, Inc., 333 Seventh Avenue, New York, NY 10001, USA. Tel.: +1(212) 584-4662

Pulmonary and Extrapulmonary Forms of Acute Respiratory Distress Syndrome

Paolo Pelosi1 , Pietro Caironi2 , Luciano Gattinoni2
  • 1Dipartimento di Scienze Cliniche e Biologiche, Università degli Studi dell'Insubria, Varese; Ospedale di Circolo, Fondazione Macchi, Varese, Italy
  • 2Istituto di Anestesia e Rianimazione, Università degli Studi di Milano, Ospedale Maggiore di Milano - IRCCS, Milano, Italy
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Publikationsdatum:
31. Dezember 2001 (online)

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ABSTRACT

Acute respiratory distress syndrome (ARDS) is usually viewed as the functional and morphological expression of a similar underlying lung injury caused by a variety of insults. However, the distinction between ARDS due to a direct (ARDSp) versus an indirect (ARDSexp) lung injury is gaining more attention as a means of better comprehending the pathophysiology of ARDS and for modifying ventilatory management. From the few published studies, we can summarize that: (1) the prevalent damage in early stages of a direct insult is intra-alveolar, whereas in indirect injury it is the interstitial edema. It is possible that the two insults may coexist (i.e., one lung with direct injury (as in pneumonia) and the other with indirect injury, through mediator release from the contralateral pneumonia); (2) the radiological pattern, by chest x-ray or computed tomography (CT), is different in ARDSp (characterized by prominent consolidation) and ARDSexp (characterized by prominent ground-glass opacification); (3) in ARDSp lung elastance is more markedly increased than in ARDSexp, where the main abnormality is the increase in chest wall elastance, due to abnormally high intra-abdominal pressure; (4) positive end-expiratory pressure (PEEP), inspiratory recruitment, and prone position are more effective to improve respiratory mechanics, alveolar recruitment, and gas-exchange in ARDSexp. Further studies are warranted to better define if the distinction between ARDS of different origins can improve clinical management and survival.

KEYWORD

Acute respiratory distress syndrome - pulmonary pneumonia - extrapulmonary pneumonia

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