Acute Respiratory Distress Syndrome: Incidence, Pathophysiology and Selected Interventions
Miller, Benjamin J.
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Acute respiratory distress syndrome (ARDS) is a clinical response to a primary or secondary pulmonary injury or insult that is associated with severe hypoxemia. The incidence of ARDS has been reported between 1.5 and 75 cases per 100,000 population per year with mortality rates reaching 45-64 %. ARDS is severe hypoxia with a Pa02/Fi02 < 200 torr from a non-cardiogenic pulmonary edema. ARDS is an end result of the Systemic Inflammatory Response Syndrome (SIRS), with a thick exudative fluid collecting in the pulmonary interstitium preventing the diffusion of oxygen across the alveolar-capillary membrane. Mechanical ventilation, supplemental oxygen and positive end expiratory pressure (PEEP) are the hallmark therapies of supportive care. The management goal for ARDS is to provide maximal oxygenation while decreasing iatrogenic complications of mechanical ventilation. Two interventions: the prone position and low tidal volume ventilation have been shown to improve oxygenation and mortality rates respectively for patients with ARDS.