Ventilatory Support in Different Stages of Lung Dysfunction
Adult respiratory distress syndrome (ARDS) is usually caused by disorders that cause intra-alveolar fluid accumulation resulting in severe ventilation-perfusion mismatch and hypoxaemia. In normal subjects, this kind of fluid accumulation is not present since the forces inducing fluid movement in and out of the intravascular space are almost in balance and also the small amount of fluid trasudation into the perivascular space (500 ml/day) is rapidly cleared by lymphatic drainage. Excluding the hypothesis of an imbalance between the forces justifying the fluids movements, the pathophysiologic mechanism behind ARDS is difficult to be understood even if the duration of the syndrome seems to play an important role. In this paper we will discuss: 1) the pathophysiology of ARDS; 2) the lung structure and function at different stages of the evolution of ARDS; 3) the possible physiopathologic and clinical implications of the observed differences.
KeywordsAdult Respiratory Distress Syndrome Lung Structure Lung Dysfunction Dependent Lung Region Dead Space Fraction
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