Postoperative adult respiratory distress syndrome: the Howard experience

To describe the natural history of adult respiratory distress syndrome (ARDS), we compared the clinical course of two groups of postoperative critically ill patients who developed respiratory failure requiring prolonged endotracheal intubation (minimum: 4 days). The two groups with ARDS (Group 1) and without ARDS (Group 2) were compared for the following clinical parameters: PO2/FIO2 ratio, cardiac index, pulmonary capillary wedge pressure, systemic and pulmonary vascular resistance, pulmonary compliance, serial chest radiograph findings, presence or absence of sepsis, oxygen transport parameters, morbidity, and mortality. Twenty patients are described over a 9-month period ending in March 1990-10 patients in each group. Characteristic differences between the two groups in terms of oxygen consumption, pulmonary compliance, pulmonary vascular resistance, numbers of organ systems failing, and mortality were noted. Our experience supports the recommendations of early institution of positive and expiratory pressure and optimizing oxygen delivery parameters in the management of ARDS.