Early identification of patients prone to develop adult respiratory distress syndrome

Fifty-nine intubated nonhypoxic patients with clinical criteria associated with adult respiratory distress syndrome were studied. Clinical measurement were sought to identify patients before severe hypoxemia occurred. Etiologic factors, chest roentgenography, effective static compliance, intrapulmonary shunt and arterial blood gases on 40 and 100 percent inspired oxygen were analyzed. Pulmonary failure occurred in 22 patients, while 37 had minimal pulmonary difficulties. Comparison of these two groups revealed that only sequential arterial oxygen tensions accurately predicted pulmonary deterioration. A 40 percent arterial oxygen pressure below 100 torr and a 100 percent oxygen pressure below 350 torr indicated a 95 percent probability of pulmonary deterioration. When either determination was above these levels, the probability of pulmonary deterioration was 10 percent. The use of sequential arterial blood gases allows the selection of high risk patients for adult respiratory distress syndrome. This ensures that therapy is offered at the most beneficial time.