The adult respiratory distress syndrome

Acute lung injury from a variety of causes may result in capillary leakage and the nonhydrostatic edema of the adult respiratory distress syndrome. The mechanism of development of this syndrome is not yet fully understood. There is increasing hypoxemia from disturbance of normal ventilation-perfusion relationships in the lung and progressive loss of compliance. Treatment is empiric and requires the supportive use of mechanical ventilation and high inspired oxygen fractions, usually with the addition of positive end-expiratory pressure in the breathing circuit. Careful monitoring of respiratory and hemodynamic variables is essential in patient care. In spite of considerable experience, the mortality rate remains high.