The Clinical Presentation and Diagnosis of the Adult Respiratory Distress Syndrome

Abstract

Patients requiring intensive care frequently develop arterial hypoxaemia and few clinicians doubt the importance of this particular complication and its management in the overall prognosis of the critically ill. Acute respiratory failure may occur following a wide variety of different insults which are traditionally divided into two groups—those which produce direct mechanical or chemical trauma to the lung (contusion, Pneumonitis following exposure to noxious gases or subsequent to the aspiration of gastric contents) and those in which the lung damage is a consequence of some distant but systemic disease process (e.g. the sepsis syndrome, severe trauma, pancreatitis). The severity of pulmonary dysfunction is extremely variable. Indeed, only a small proportion of the hypoxaemic population, resistant to the effects of oxygen or continuous positive airway pressure by facemask, require endotracheal intubation and mechanical ventilation. Similarly, of those patients requiring assisted ventilation, only a small minority go on to demonstrate the classical features of the so-called adult respiratory distress syndrome (ARDS).