Pathophysiology of ARDS

  • D. Chiumello
  • C. S. Valente Barbas
  • P. Pelosi


Acute respiratory distress syndrome (ARDS) is a quite common disease, with an annual incidence ranging from 1.5 to 8.3 cases for every 100000 patients and a mortality of 30–50% [1]. In 1994, the American European Consensus Conference defined ARDS as: ‘an acute and persistent lung disease characterized by an arterial hypoxemia (PaO2/FiO2<200 mmHg), resistant to oxygen therapy and bilateral infiltrates on chest X ray’ [2]. In general, ARDS has two different pathogeneses: a direct ‘pulmonary’ insult to the lung cell or an indirect “extrapulmonary’ insult resulting in a systemic inflammatory response. ARDS is a progressive disease, with different stages, different mediators, and both inflammatory and anti-inflammatory activity (cellular and humoural). At the beginning of the inflammatory response, changes occur in the alveolar capillary barrier, including the formation of a protein-rich fluid, alteration of surfactant and migration into the lung of neutrophils, lymphocytes and macrophages. Plasma factors, such as complement, and mediators generated by the cells, such as cytokines, oxidants and leucotrienes, are secreted inappropriately and at high levels. Resolution of the disease starts with a decrease in the levels of inflammatory mediators, the migration of fibroblasts into the lung, collagen deposition and the re-absorption of oedema fluid.


Lung Injury Acute Lung Injury Acute Respiratory Distress Syndrome Respir Crit Adult Respiratory Distress Syndrome 
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Copyright information

© Springer 2008

Authors and Affiliations

  • D. Chiumello
    • 1
  • C. S. Valente Barbas
    • 2
  • P. Pelosi
    • 3
  1. 1.Institute of Anaesthesia and Critical CareUniversity of Milan, Policlinico IRCCS HospitalMilanItaly
  2. 2.Departamento de Cardio-Pneumologia e Patologia da Faculdade de Medicina da Universidade de São PauloBrazil
  3. 3.Department of Clinical ScienceUniversity of InsubriaVareseItaly

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