Abstract
Triggering of the systemic inflammatory response syndrome (SIRS) by conditions such as sepsis, multisystem trauma, shock (and massive transfusions), burns, and pancreatitis produces a pulmonary vascular flood of products of the activated humoral cascade system, where inflammatory cells, bacterial toxins, and toxin-produced cellular mediators clearly assume responsibility. Depending on its severity this diffuse injury is characterized as acute lung injury (ALI) or acute respiratory distress syndrome (ARDS). ALI is a syndrome of inflammation and increased permeability that leads to physiologic, radiologic, and clinical abnormalities. When ALI is severe, ARDS is the term used to describe the condition. The consensus definition of ALI includes (1) acute onset; (2) PaO2/FiO2 ≤ 300; (3) bilateral infiltrates on frontal chest radiograph; and (4) pulmonary artery wedge pressure ≤ 18 mmHg, or in the absence of a pulmonary artery catheter no clinical evidence of left atrial hypertension.1 The consensus definition of ARDS is ALI with PaO2/FiO2 ≤ 200. Although ARDS can be primary (due to direct causes such as pneumonia and gas inhalation), it is more strongly linked to outside lung events, which appear to trigger the systemic inflammatory syndrome (SIRS). This type of ARDS is called secondary (or indirect) and is often associated with the multiple organ dysfunction syndrome (MODS).
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Keywords
- Nitric Oxide
- Acute Lung Injury
- Systemic Inflammatory Response Syndrome
- Acute Respiratory Distress Syndrome
- Injury Severity Score
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.
References
Bernard GR, Artigas A, Brigham KL, et al: The American-European consensus conference on ARDS: definitions, mechanisms, relevant outcomes, and clinical trial coordination. Am J Respir Crit Care Med 1994; 149: 818–824.
Garber BG, Herbert PC, Yelle JD, et al: Adult respiratory distress syndrome: a systemic overview of incidence and risk factors. Crit Care Med 1996; 24: 687–695.
Bell RC, Coalson JJ, Smith JD: Multiple-organ system failure and infection in the adult respiratory distress syndrome. Ann Intern Med 1983; 99: 293–298.
Knaus WA, Sun X, Hakim RB, Wagner DP: Evaluation of definitions for adult respiratory distress syndrome. Am J Respir Crit Care Med 1994; 150: 311–317.
Herbert PC, Drummond AJ, Singer J, et al: A simple multiple system organ failure scoring system predicts mortality of patients who have sepsis syndrome. Chest 1993; 104: 230–235.
Temmesfeld-Wollbrück B, Walmrath D, Grimminger F, Seeger J: Prevention and therapy of the adult respiratory distress syndrome. Lung 1995; 173: 139–164.
Sinclair DG, Haslam PL, Quinlan GJ, et al: The effect of cardiopulmonary bypass on intestinal and pulmonary endothelial permeability. Chest 1995; 108: 718–724.
Bone RC, Balk R, Slotman G, et al: Adult respiratory distress syndrome: sequence and importance of development of multiple organ failure. Chest 1992; 101: 320–326.
Pepe PE, Potkin RT, Reus DH, et al: Clinical predictors of the adult respiratory distress syndrome. Am J Surg 1982; 144: 124–129.
Hudson LD, Milberg JA, Anaardi D, Maunder RJ: Clinical risks for development of the acute respiratory distress syndrome. Am J Respir Crit Care Med 1995; 151: 293–301.
Roumen RMH, Redl H, Schlat G, et al: Scoring systems and blood lactate concentrations in relation to the development of adult respiratory distress syndrome and multiple organ failure in severely traumatized patients. J Trauma 1993; 35: 349–355.
Slotman GJ, Quinn JV: Multivariate regression modeling for the prediction of inflammation, systemic pressure, and end-organ function in severe sepsis. Shock 1997; 8: 225–231.
Connelly KG, Moss M, Parsons PE, et al: Serum ferritin as a predictor of the acute respiratory distress syndrome. Am J Respir Crit Care Med 1997; 155: 21–25.
Donnelly SC, MacGregor I, Zamani A, et al: Plasma elastase levels and the development of the adult respiratory distress syndrome. Am J Respir Crit Care Med 1995; 151: 1428–1433.
Douzinas EE, Tsidemidou PD, Piteridis NT, et al: The regulation and production of cytokines and lactate in sepsis related multiple organ failure. Am J Respir Crit Care Med 1997; 55: 53–59.
Roumen RMH, Hendriks T, DeMan BM, Goris RJA: Serum lipofuscin as a prognostic indicator of adult respiratory distress syndrome and multiple organ failure. Br J Surg 1994; 81: 1300–1305.
Montgomery AB, Stager MA, Carrico CJ, Hudson LD: Causes of mortality in patients with the adult respiratory distress syndrome. Am Rev Respir Dis 1985; 132: 485–489.
Russell JA, Ronco JJ, Lockhat D, et al: Oxygen delivery and consumption and ventricular preload are greater in survivors than in nonsurvivors of the adult respiratory distress syndrome. Am Rev Respir Dis 1990; 140: 659–665.
Suchyta RM, Clemmer TP, Elliott CG, et al: The adult respiratory distress syndrome: a report of survival and modifying factors. Chest 1992; 101: 1074–1079.
Clark JG, Milbert JA, Steinberg KP, Hudson LD: Type III procollagen peptide in the adult respiratory distress syndrome: association of increased peptide levels in bronchoalveolar lavage fluid with increased risk for death. Ann Intern Med 1995; 122: 17–23.
Donnelly SC, Strieter RM, Reid PT, et al: The association between mortality rates and decreased concentrations of interleu-kin-10 and interleukin-1 receptor agonist in the lung fluids of patients with the adult respiratory syndrome. Ann Intern Med 1996; 125: 191–196.
Headley AS, Tolley E, Meduri GU: Infections and the inflammatory response in acute respiratory distress syndrome. Chest 1997; 111: 1306–1321.
Milberg JA, Davis DR, Steinberg KP, Hudson LD: Improved survival of patients with acute respiratory distress syndrome (ARDS): 1983-1993. JAMA 1995; 273: 306–309.
Abel SJC, Finney SJ, Brett SJ, et al: Reduced mortality in association with the acute respiratory distress syndrome (ARDS). Thorax 1998; 53: 292–294.
Zilberberg MD, Epstein SK: Acute lung injury in the medical ICU: comorbid conditions, age, etiology, and hospital outcome. Am J Respir Crit Care Med 1998; 157: 1159–1164.
Humphrey H, Hall J, Sznajder I, et al: Improved survival in ARDS patients associated with a reduction in pulmonary capillary wedge pressure. Chest 1990; 97: 1176–1180.
Cerra FB, Maddaus MA, Dunn DL, et al: Selective gut decontamination reduces nosocomial infections and length of stay but not mortality or organ failure in surgical intensive care unit patients. Arch Surg 1992; 127: 163–169.
Garcia MS, Cambronero JA, Diaz JL, et al: Effectiveness and cost of selective decontamination of the digestive tract in critically ill incubated patients. Am J Respir Crit Care Med 1998; 158: 908–916.
Vallés J, Artigas A, Rello J, et al: Continuous aspiration of subglottic secretions in preventing ventilator-associated pneumonia. Ann Intern Med 1995; 122: 179–186.
Chastre J, Fagon JY: Invasive diagnostic testing should be routinely used to manage ventilated patients with suspected pneumonia. Am J Respir Crit Care Med 1994; 150: 570–574.
Bonten MJM, Bergmans CJJ, Stobberingh EE, et al: Implementation of bronchoscopic techniques in the diagnosis of ventilator-associated pneumonia to reduce antibiotic use. Am J Respir Crit Care Med 1997; 156: 1820–1824.
Niederman MS, Torres A, Summer W: Invasive diagnostic testing is not needed routinely to manage suspect ventilator-associated pneumonia. Am J Respir Crit Care Med 1994; 150: 565–569.
Souweine B, Veber B, Bedos JP, et al: Diagnostic accuracy of protected specimen brush and bronchoalveolar lavage in nosocomial pneumonia: impact of previous antimicrobial treatments. Crit Care Med 1998; 26: 236–244.
Heyland DK, MacDonald S, Keefe L, Drover JW: Total parenteral nutrition in the critically ill patient: a meta-analysis. JAMA 1998; 280: 2013–2019.
Mead J, Takishima T, Leith D: Stress distribution in lungs: a model of pulmonary elasticity. J Appl Physiol 1970; 28: 596–608.
Marini JJ: Ventilation of the acute respiratory distress syndrome: looking for Mr. Goodmode [editorial]. Anesthesiology 1994; 80: 972–974.
Slutsky AS, Tremblay LN: Multiple system organ failure: is mechanical ventilation a contributing factor? Am J Respir Crit Care Med 1998; 157: 1721–1725.
Desai SR, Hansell DM: Lung imaging in the adult respiratory distress syndrome: current practice and new insights. Intensive Care Med 1997; 23: 7–15.
Marini JJ: Tidal volume, PEEP and barotrauma: an open shut case [editorial]? Chest 1996; 109: 302–304.
Tuxen DV; Permissive hypercapnic ventilation. Am J Respir Crit Care Med 1994; 150: 870–874.
Balk R: Permissive hypercapnia: an alternative ventilatory mode for the management of acute lung injury and acute airflow obstruction. Clin Pulm Med 1997; 4: 29–33.
Stewart TE, Meade MO, Cook DJ, et al: Evaluation of a ventilation strategy to prevent barotrauma in patients at high risk for acute respiratory distress syndrome. N Engl J Med 1998; 338: 255–361.
Amato MBP, Barbas CSV, Medeiros DM, et al: Effect of a protective-ventilation strategy on mortality in the acute respiratory distress syndrome. N Engl J Med 1998; 338: 347–354.
Artigas A, Bernard GR, Carlet J, et al: The American-European consensus conference on ARDS. Part 2. Ventilatory, pharmacologic, supportive therapy, study design strategies, and issues related to recovery and remodeling. Am J Respir Crit Care Med 1998; 157: 1332–1347.
Armstrong BW, MacIntyre NR: Pressure-controlled, inverse ratio ventilation that avoids air trapping in the adult respiratory distress syndrome. Crit Care Med 1995; 23: 279–285.
Rappaport SH, Shpiner R, Yoshihara G, Wright J, Chang P, Abraham E: Randomized, prospective trial of pressure-limited versus volume-controlled ventilation in severe respiratory failure. Crit Care Med 1994; 22: 22–32.
Tharratt RS, Allen RP, Albertson TE: Pressure controlled inverse ratio ventilation in severe adult respiratory failure. Chest 1988; 94: 755–762.
Barie PS: Organ-specific support in multiple organ failure: pulmonary support. World J Surg 1995; 19: 581–591.
Marini JJ: Down side up—a prone and partial liquid asset. Intensive Care Med 1995; 21: 963–965.
Pappert D, Rossaint R, Slama K, Gruning T, Falke KJ: Influence of positioning on ventilation-perfusion relationships in severe adult respiratory distress syndrome. Chest 1994; 106: 1511–1516.
Pelosi P, Tubiolo D, Maseheroni D, et al: Effects of the prone position on respiratory mechanics and gas exchange during acute lung injury. Am J Respir Crit Care Med 1998; 157: 387–393.
Dellinger RP: Inhaled nitric oxide in cardiopulmonary disease. In: Cernaianu AC (ed) Critical Issues in Surgery. New York, Plenum (in press)
Rossaint R, Falke KF, Lopez F, et al: Inhaled nitric oxide for the adult respiratory distress syndrome. N Engl J Med 1993; 328: 399–405.
Puybasset L, Rouby JJ, Mourgeon E, et al: Inhaled nitric oxide in acute respiratory failure: dose-response curves. Intensive Care Med 1994; 20: 319–327.
Dellinger RP, Zimmerman JL, Taylor RW, et al: Effects of inhaled nitric oxide in patients with acute respiratory distress syndrome: results of a randomized phase II trial. Crit Care Med 1998; 26: 15–23.
Kavanagh B, Mouchawar A, Goldsmith J, Pearl R: Effects of inhaled NO and inhibition of endogenous NO synthesis in oxidant-induced acute lung injury. J Appl Physiol 1994; 76: 1324–1329.
Poss W, Timmons O, Farrukh I, et al: Inhaled nitric oxide prevents the increase in pulmonary vascular permeability caused by hydrogen peroxide. J Appl Physiol 1995; 79: 886–891.
Chollet-Martin S, Gatecel C, Kermarrec N, et al: Alveolar neutrophil functions and cytokine levels in patients with adult respiratory distress syndrome during nitric oxide inhalation. Am J Respir Crit Care Med 1996; 153: 985–990.
Benzing A, Brautigam P, Geiger K, et al: Inhaled nitric oxide reduces pulmonary transvascular albumin flux in patients with acute lung injury. Anesthesiology 1995; 83: 1153–1161.
Lundin S, Mang H, Smithies M, et al: Inhalation of nitric oxide in acute lung injury: preliminary results of a European multicenter study. Intensive Care Med 1997; 23(Suppl 1): S2.
Groupe d’Etude sur le NO Inhale’ au Course le 1’ARDS (GENOA): Inhaled NO ARDS: presentation of double blind randomized multicentric study [abstract]. Am J Respir Crit Care Med 1996; 153: A590.
Mathisen DJ, Kuo EY, Hahn C, et al: Inhaled nitric oxide for adult respiratory distress syndrome after pulmonary resection. Ann Thorac Surg 1998; 65: 1–9.
Rossaint R, Slama K, Steudel W, et al: Effects of inhaled nitric oxide on right ventricular function in severe acute respiratory distress syndrome. Intensive Care Med 1995; 21: 97–203.
Meyer J, Theilmeier G, Van Aken H, et al: Inhaled prostaglandin E1 for treatment of acute lung injury in severe multiple organ failure. Anesth Analg 1998; 86: 753–758.
Pappert D, Busch T, Gerlach G, et al: Aerosolized prostacyclin versus inhaled nitric oxide in children with severe acute respiratory distress syndrome. Anesthesiology 1995; 82: 1507–1511.
Hirschl RB, Pranikoff T, Wise C, et al: Initial experience with partial liquid ventilation in adult patients with the acute respiratory distress syndrome. JAMA 1996; 275: 383–389.
Meduri GU: The role of the host defense response in the progression and outcome of ARDS: pathophysiological correlations and response to glucocorticoid treatment. Eur Respir J 1996; 9: 2650–2670.
Headley AS, Tolley E, Meduri GU: Infections and the inflammatory response in acute respiratory distress syndrome. Chest 1997; 111: 1306–1321.
Meduri GU, Headley AS, Golden E, et al: Effect of prolonged methylprednisolone therapy in unresolving acute respiratory distress syndrome. JAMA 1998; 280: 159–165.
Anzueto A, Baughman RP, Guntupalli KK, et al: Aerosolized surfactant in adults with sepsis-induced acute respiratory distress syndrome: Exosurf Acute Respiratory Distress Syndrome Sepsis Study Group. N Engl J Med 1996; 334: 1417–1421.
Arnold J: Surfactant replacement in acute lung injury—the saga continues. Crit Care Med 1999; 27: 31–32.
Jepsen S, Herlevsen P, Knudsen P, Bud MI, Klausen NO: Antioxidant treatment with N-acetylcysteine during adult respiratory distress syndrome: a prospective, randomized, placebo-controlled study. Crit Care Med 1992; 20: 918–923.
Bernard GR, Wheeler AP, Russell JA, et al: The effects of ibuprofen on the physiology and survival of patients with sepsis. N Engl J Med 1997; 336: 912–918.
Dellinger RP: Severe sepsis: any hope? In: Cernaianu AC (ed) Critical Issues in Surgery. New York, Plenum (in press)
Fuhrman BP, Abraham E, Dellinger RP; Futility of randomized. controlled ARDS trials: a new approach is needed. Crit Care Med 1999; 27: 431–433.
Bernard G: Research in sepsis and acute respiratory distress syndrome: are we changing course? Grit Care Med 1999; 27: 434–436.
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Dellinger, R.P. (2000). Lung. In: Baue, A.E., Faist, E., Fry, D.E. (eds) Multiple Organ Failure. Springer, New York, NY. https://doi.org/10.1007/978-1-4612-1222-5_36
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DOI: https://doi.org/10.1007/978-1-4612-1222-5_36
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