Pathophysiologic insights into acute respiratory failure

Luciano Gattinoni, Paolo Pelosi

Research output: Contribution to journalArticlepeer-review


The lung is homogeneously affected by the disease process during the early phase of acute respiratory distress syndrome. This leads to an homogeneous alteration of the vascular permeability. Consequently, the edema accumulates evenly in all lung regions (nongravitational distribution). The increased lung weight, through the transmission of hydrostatic forces, however, causes a collapse of the lung regions along the vertical axes (compression atelectasis). At plateau pressure, the pulmonary units reopen, and during the following expiration they stay open, if the applied positive end-expiratory pressure is adequate. Positive end-expiratory pressure is adequate if it is equal or higher than the hydrostatic forces compressing that unit. Prone position is another maneuver effective in keeping open pulmonary units that were previously collapsed. During late acute respiratory distress syndrome, the compression atelectasis does not exist due to the edema reabsorption, and the lung undergoes structural changes, usually associated with carbon dioxide retention and development of emphysema-like lesions.

Original languageEnglish
Pages (from-to)8-12
Number of pages5
JournalCurrent Opinion in Critical Care
Issue number1
Publication statusPublished - 1996

ASJC Scopus subject areas

  • Critical Care and Intensive Care Medicine


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