Chest
Volume 76, Issue 2, August 1979, Pages 180-186
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Evaluation of the Progress and Prognosis of Adult Respiratory Distress Syndrome: Simple Respiratory Physiologic Measurement

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In our study of 14 patients with adult respiratory distress syndrome (ARDS), we measured A-aDO2, Vd/Vt, arterial-to-end tidal Pco2 difference (a-etPco2), effective dynamic compliance, and pulmonary vascular resistance on a daily basis. At the onset of ARDS, all patients showed bilateral interstitial edema on the chest x-ray films, P(A-a)O2 of more than 500 mm Hg, marked decrease in effective dynamic compliance, a moderate increase in Vd/Vt, and a normal value of a-etPco2. Pulmonary vascular resistance was low. After seven days, all of those who subsequently died had developed persistent elevation of P(A-a)O2, significant increase in Vd/Vt, a-etPco2 and pulmonary vascular resistance, and significant decrease in effective dynamic compliance compared to the values at the onset of ARDS. Those abnormalities diverged significantly from the findings in those who survived. By evaluating sequential changes of those parameters, we might be able to predict an accurate prognosis of ARDS.

Section snippets

MATERIALS AND METHODS

We studied 14 consecutive patients who developed acute respiratory failure and were treated in the intensive care unit at the Osaka University Hospital between April, 1974 and April, 1977. All fulfilled the following criteria: 1) no apparent prior pulmonary disorders prior to shock, trauma, or surgical stress; 2) marked hypoxemia (P[A-a]O2 of more than 500 mm Hg); 3) diffuse bilateral infiltrates without cardiac enlargement on chest films; 4) clinical signs of respiratory distress, such as

RESULTS

Of the 14 patients with ARDS, four recovered from acute respiratory failure. The over-all mortality was 71.4 percent.

DISCUSSION

There is a wide variety of studies concerning the pathology and pathophysiology of ARDS. Still there are a great number of patients who develop acute respiratory failure in the intensive care unit. The mortality rate for these patients is remarkably high. The lack of definite criteria of ARDS makes the precise evaluation of the results of experimental and clinical studies difficult. We have selected 14 consecutive patients who developed acute hypoxemia (P[A-a]O2 of more than 500 mm Hg) within

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Manuscript received September 5; revision accepted December 5.

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