Pathophysiology of shock and adult respiratory distress syndrome

The respiratory failure that develops in surgical patients is usually caused by a surgical problem--shock, trauma, sepsis, pulmonary contusion, aspiration, pulmonary emboli or pain, with its attendant ventilatory compromise. Although the underlying pathophysiology for the respiratory failure in these conditions is not precisely known, the means for prevention are well known. Patients subjected to trauma should be aggressively resuscitated from shock. They should have the chance of being cared for in a facility where an operation can be performed promptly. The respiratory failure of sepsis is best treated by seeking out foci of pus or devitalized tissue and surgically ablating these foci when found. Adherence to these basic surgical principles--aggressive resuscitation of patients in shock and prompt attention to their surgical problems--will alleviate much of the respiratory distress of surgical patients, no matter what the pathophysiology or etiology may be.