Pulmonary and extrapulmonary acute respiratory distress syndrome are different

P. Pelosi, D. D'Onofrio, D. Chiumello, S. Paolo, G. Chiara, V. L. Capelozzi, C. S V Barbas, M. Chiaranda, L. Gattinoni

Research output: Contribution to journalArticle

158 Citations (Scopus)

Abstract

Acute respiratory distress syndrome (ARDS) can be derived from two pathogenetic pathways: a direct insult on lung cells (pulmonary ARDS (ARDSp)) or indirectly (extrapulmonary ARDS (ARDSexp)). This review reports and discusses differences in biochemical activation, histology, morphological aspects, respiratory mechanics and response to different ventilatory strategies between ARDSp and ARDSexp. In ARDSp the direct insult primarily affects the alveolar epithelium with a local alveolar inflammatory response while in ARDSexp the indirect insult affects the vascular endothelium by inflammatory mediators through the bloodstream. Radiological pattern in ARDSp is characterised by a prevalent alveolar consolidation while the ARDSexp by a prevalent ground-glass opacification. In ARDSp the lung elastance, while in ARDSexp the chest wall and intra-abdominal chest elastance are increased. The effects of positive end-expiratory pressure, recruitment manoeuvres and prone position are clearly greater in ARDSexp. Although these two types of acute respiratory distress syndrome have different pathogenic pathways, morphological aspects, respiratory mechanics, and different response to ventilatory strategies, at the present, is still not clear, if this distinction can really ameliorate the outcome.

Original languageEnglish
JournalEuropean Respiratory Journal, Supplement
Volume22
Issue number42
Publication statusPublished - Aug 2003

Fingerprint

Adult Respiratory Distress Syndrome
Respiratory Mechanics
Lung
Prone Position
Positive-Pressure Respiration
Vascular Endothelium
Thoracic Wall
Glass
Histology
Thorax
Epithelium

Keywords

  • Computed tomography
  • Positive end-expiratory pressure
  • Prone position
  • Pulmonary and extrapulmonary acute respiratory distress syndrome
  • Respiratory mechanics
  • Ventilator-induced lung injury

ASJC Scopus subject areas

  • Pulmonary and Respiratory Medicine

Cite this

Pelosi, P., D'Onofrio, D., Chiumello, D., Paolo, S., Chiara, G., Capelozzi, V. L., ... Gattinoni, L. (2003). Pulmonary and extrapulmonary acute respiratory distress syndrome are different. European Respiratory Journal, Supplement, 22(42).

Pulmonary and extrapulmonary acute respiratory distress syndrome are different. / Pelosi, P.; D'Onofrio, D.; Chiumello, D.; Paolo, S.; Chiara, G.; Capelozzi, V. L.; Barbas, C. S V; Chiaranda, M.; Gattinoni, L.

In: European Respiratory Journal, Supplement, Vol. 22, No. 42, 08.2003.

Research output: Contribution to journalArticle

Pelosi, P, D'Onofrio, D, Chiumello, D, Paolo, S, Chiara, G, Capelozzi, VL, Barbas, CSV, Chiaranda, M & Gattinoni, L 2003, 'Pulmonary and extrapulmonary acute respiratory distress syndrome are different', European Respiratory Journal, Supplement, vol. 22, no. 42.
Pelosi P, D'Onofrio D, Chiumello D, Paolo S, Chiara G, Capelozzi VL et al. Pulmonary and extrapulmonary acute respiratory distress syndrome are different. European Respiratory Journal, Supplement. 2003 Aug;22(42).
Pelosi, P. ; D'Onofrio, D. ; Chiumello, D. ; Paolo, S. ; Chiara, G. ; Capelozzi, V. L. ; Barbas, C. S V ; Chiaranda, M. ; Gattinoni, L. / Pulmonary and extrapulmonary acute respiratory distress syndrome are different. In: European Respiratory Journal, Supplement. 2003 ; Vol. 22, No. 42.
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