[Pathogenetic mechanisms in acute respiratory failure in adults]

A large variety of mediators and mediator systems are involved in the pathogenesis of acute respiratory failure in adults, and the complexity of the syndrome should be considered in both prophylaxis and therapy. The locally accentuated and organ-related activation of several mediator systems over a long period of time is likely to be responsible for the irreversible damage to cells and tissue. Surfactant dysfunction or degradation, regardless of the cause, contributes to the pathophysiology of severe respiratory failure, and might be a common denominator in the pathogenesis of the syndrome. Cytokines from macrophages are important, since these mediators have the potential to convert a primarily functional and reversible systemic reaction into irreversible damage to specific organs.