Post-traumatic respiratory distress syndrome.

During the past two decades there has been recognition of the role of acute respiratory failure in the deaths of patients with shock from any cause. Leaky capillaries are the common pathophysiologic event. The pulmonary capillary bed is affected by the toxic action of vasoactive substances, gastric aspirates, and fat embolism; by the obstructive action of platelet, fibrin, and leukocyte clots; and by changes in the balance between perfusion pressures and oncotic pressures. This is complicated by increases in pulmonary vascular pressures from associated heart disease or overenthusiastic replacement of blood volume. The early treatment of the shock state, early intubation and ventilation, and the use of agents designed to improve capillary integrity have led to a significant reduction in mortality from this common problem.