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ACUTE RESPIRATORY DISTRESS-SYNDROME

Acute respiratory distress-syndrome (ARDS) — it is a pulmonary response to local or systemic hypoxia of tissues, their ischemia and reperfusion; it is a dynamic pathologic process with a multifactor etiology. Inflammatory process in the lungs is associated with many factors: activation of polymorphonuclear neutrophils (PNN), endotheliocytes and production of free oxygen radicals. In the pathogenesis there is unadjustable edema of the lungs as a result of injury of alveolo-capillary membrane.

Etiology of ARDS.

Main etiologic factors of ARDS are:

— sepsis;

— aspiration of acidic content;

— multiple trauma;

— long-standing arterial hypertension;

— burns;

— pancreatitis, peritonitis;

— DIC-syndrome;

— massive hemotransfusions (>3-3.5 1/day);

— shock of various etiology;

— eclampsia;

— drowning;

— malignant tumors and leukoses (chemotherapy);

— poisonings (heroin, phenylephrine hydrochloride and others);

— prolonged extracorporal perfusion;

— psoriasis, erythrodermia;

— pulmonary tuberculosis (miliary);

— idiopathic syndrome of antibody formation to phospholipids. Pathogenesis of ARDS

A primary lesion of microvessels of pulmonary circuit of blood circulation lies in the basis of ARDS. One of the main triggers of ARDS is severe disorders of the peripheral blood circulation at the level of microcirculation ("crisis of microcirculation").

The other important mechanism in the development of ARDS is a general nonspecific inflammatory reaction.

The inflammatory reaction is accompanied by a release into blood and activation of great number of biologically active compounds, mediators of inflammation that exert their effect on hemodynamics, transport functions and blood coagulating system, immunity, level of metabolism, etc.

Pulmonary edema in ARDS, at first, bears a noncardiogenic nature. Hereinafter, a right ventricular failure advances resulting in the syndrome of polyorganic insufficiency.

Clinical manifestations of ARDS are presented in Table 11.

Table 11

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