Adult respiratory distress syndrome

Treatment of the adult respiratory distress syndrome requires an understanding of the current concepts of the pathogenesis of this syndrome. The clinical features and pathophysiology are briefly discussed. Differential diagnosis requires the exclusion of pulmonary infection and left heart failure. Therapy is aimed at correction of the associated initiating disease process and the maintenance of tissue oxygenation. The latter requires increased inspired oxygen concentration, maintenance of an adequate cardiac output, and maintenance of a normal hematocrit level and body temperature. The therapeutic role of intravenous albumin, diuretics, and steroids in this syndrome is still controversial. Currently accepted modalities for improving oxygenation, when oxygen by face mask proves inadequate, include intubation and ventilation with postiive end-expiratory pressure. Other promising technics for improving oxygenation which do not require intubation are continuous positive airway pressure applied by face mask, continuous negative chest wall pressure, and alterations in posture. The long-term prognosis in survivors appears to be good, with only mild residual pulmonary functional abnormalities.