The respiratory distress syndrome.

Acute RDS is a clinical and pathologic phenomenon with many causes. Some of the pulmonary problems are iatrogenic, resulting from the overuse of blood, crystalloids, oxygen, vasopressors, sedation, and immobility. Some are related to the blast effects of injuries at sites distant from the thorax. Other causative factors are metabolic, secondary to diminished peripheral perfusion. The pulmonary capillary bed is a principal target organ in shock--affected by the toxic action of vasoactive substances, gastric aspirates, and fat; by the obstructive action of platelet, fibrin, and leukocyte clots; and by changes in balance between perfusion pressures and oncotic pressures. The rationale of prevention and therapy presented here has resulted (except in those patients with prolonged sepsis) in almost complete disappearance of RDS as a cause of death in our institution.