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 language | English |
|---|---|
| Journal | European Respiratory Journal, Supplement |
| Volume | 22 |
| Issue number | 42 |
| Publication status | Published - Aug 2003 |
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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
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 journal › Article
}
TY - JOUR
T1 - Pulmonary and extrapulmonary acute respiratory distress syndrome are different
AU - Pelosi, P.
AU - D'Onofrio, D.
AU - Chiumello, D.
AU - Paolo, S.
AU - Chiara, G.
AU - Capelozzi, V. L.
AU - Barbas, C. S V
AU - Chiaranda, M.
AU - Gattinoni, L.
PY - 2003/8
Y1 - 2003/8
N2 - 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.
AB - 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.
KW - Computed tomography
KW - Positive end-expiratory pressure
KW - Prone position
KW - Pulmonary and extrapulmonary acute respiratory distress syndrome
KW - Respiratory mechanics
KW - Ventilator-induced lung injury
UR - http://www.scopus.com/inward/record.url?scp=0043026771&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=0043026771&partnerID=8YFLogxK
M3 - Article
C2 - 12946001
AN - SCOPUS:0043026771
VL - 22
JO - European Journal of Respiratory Diseases
JF - European Journal of Respiratory Diseases
SN - 0903-1936
IS - 42
ER -