Ventilatory Support in Different Stages of Lung Dysfunction

  • L. Brazzi
  • I. Ravagnan
  • L. Gattinoni
Conference paper


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.


Adult Respiratory Distress Syndrome Lung Structure Lung Dysfunction Dependent Lung Region Dead Space Fraction 
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.


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    Gattinoni L, Bombino M, Pelosi P et al (1994) Lung structure and function in different stages of severe adult respiratory distress syndrome. JAMA 271:1772–1779PubMedCrossRefGoogle Scholar
  2. 2.
    Sanders C (1991) The radiographic diagnosis of emphysema. Radiol Clin North Am 29: 1019–1030PubMedGoogle Scholar
  3. 3.
    Gattinoni L, Pesenti A, Bombino M et al (1988) Relationship between lung computed tomographic density, gas exchange and PEEP in adult respiratory failure. Anesthesiology 69: 824–832PubMedCrossRefGoogle Scholar
  4. 4.
    Dantzker DR, Brook LJ, Dehart P et al (1979) Ventilation perfusion distributions in the ARDS. Am Rev Respir Dis 120:1039–1052PubMedGoogle Scholar
  5. 5.
    Gattinoni L, D’Andrea L, Pelosi P et al (1993) Regional effects and mechanism of positive end-expiratory pressure in early adult respiratory distress syndrome. JAMA 269:2122–2127PubMedCrossRefGoogle Scholar
  6. 6.
    Gattinoni L, Pelosi P, Vitale G et al (1991) Body position changes redistribute lung computed tomographic density in patients with acute respiratory failure. Anesthesiology 74:15–23PubMedCrossRefGoogle Scholar
  7. 7.
    Churg A, Golden J, Fligiel S et al (1983) Bronchopulmonary dysplasia in the adult. Am Rev Respir Dis 127:117–120PubMedGoogle Scholar
  8. 8.
    Slavin G, Nunn JF, Crow J et al (1982) Bronchiolectasis: a complication of artificial ventilation. BMJ 28:931–934CrossRefGoogle Scholar
  9. 9.
    Lemaire F, Harf A, Teisseire BP (1985) Oxygen exchange across the acutely injured lung. In: Zapol WM, Falke K (eds) Acute respiratory failure. Marcel Dekker, New York, pp 521–552Google Scholar
  10. 10.
    Tomashefski JF Jr, Davies P, Boggis C et al (1983) The pulmonary vascular lesions of the adult respiratory distress syndrome. Am J Pathol 112:112–126PubMedGoogle Scholar
  11. 11.
    Snow RL, Davies P, Pontoppidan P et al (1982) Pulmonary vascular remodelling in adult respiratory distress syndrome. Am Rev Respir Dis 126:887–892PubMedGoogle Scholar
  12. 12.
    Maunder RJ, Shuman WP, McHugh JW et al (1986) Preservation of normal lung regions in the adult respiratory distress syndrome: analysis by computed tomography. JAMA 255: 2463–2465PubMedCrossRefGoogle Scholar
  13. 13.
    Gattinoni L, Pelosi P, Suter PM et al (1998) Acute respiratory distress syndrome caused by pulmonary and extrapulmonary disease. Am J Respir Crit Care Med 157 (in press)Google Scholar

Copyright information

© Springer-Verlag Italia 1999

Authors and Affiliations

  • L. Brazzi
    • 1
  • I. Ravagnan
    • 1
  • L. Gattinoni
    • 1
  1. 1.Dept. of Anaesthesia and Intensive CareMaggiore Hospital — IRCCSMilanItaly

Personalised recommendations