Mancebo J
Servicio de Medicina Intensiva. Hospital de la Santa Creu i Sant Pau, Barcelona, Spain.
Rev Esp Anestesiol Reanim. 2001 Dec;48(10):465-70.
The pathophysiology of acute respiratory distress syndrome (ARDS) is characterized by pulmonary edema due to extravasation from capillary lesions in the endothelium. A clinical diagnosis is made when there is a predisposing cause (sepsis and pneumonia being the most common) that gives rise to acute respiratory insufficiency (PaO2/FiO2 ratio (3/4) 200 mmHg, bilateral infiltrates visible on a chest film and hemodynamic or other clinical signs of left cardiac insufficiency). Most patients require invasive support ventilation at a high FiO2 and positive end-expiratory pressure (PEEP). The only therapeutic approach available at this time associated with a highly significant decrease in mortality in patients with ARDS is ventilation at low flow volumes (6 ml/kg) and moderate levels of PEEP (approximately 10 cmH2O).
急性呼吸窘迫综合征（ARDS）的病理生理学特征是由于内皮细胞毛细血管病变导致的肺水肿。当存在诱发原因（最常见的是败血症和肺炎）导致急性呼吸功能不全（动脉血氧分压/吸入氧分数值（PaO2/FiO2）<200 mmHg，胸部X光片可见双侧浸润影以及左心功能不全的血流动力学或其他临床体征）时，可作出临床诊断。大多数患者需要在高吸入氧分数值和呼气末正压（PEEP）的情况下进行有创支持通气。目前唯一与ARDS患者死亡率显著降低相关的治疗方法是低流量（6 ml/kg）通气和中等水平的PEEP（约10 cmH2O）。
