Acute Respiratory Distress Syndrome 4

download Acute Respiratory Distress Syndrome 4

of 23

Transcript of Acute Respiratory Distress Syndrome 4

  • 8/9/2019 Acute Respiratory Distress Syndrome 4

    1/23

    DIF 2>%2?7%4%2?47:>>2;2:>;2?47-2?=7Olast

    @bttlbvZiv G% Jziwaz# Cizzbfea J% Wbza# V}as Jaztlfbq`a bed @folbac B%

    (Tzabt`aet im BZD_

    ltt~8))www%olasthiqzebc%izg)oietaet)2:>)4)2?47%mqcc%lt`c

    bed saz}foas obe ja miqed iecfea ie tla Wizcd Wfda Waj bt8Tla iecfea }azsfie im tlfs bztfoca# bcieg wftl q~dbtad femiz`btfie

    & F__E8>>2:-?=6:ltt~8))www%olasthiqzebc%izg)sfta)`fso)za~zfets%|lt`c,im tla oi~vzfglt licdaz%`bv ja za~zidqoad iz dfstzfjqtad wftliqt tla ~zfiz wzfttae ~az`fssfie^DMEiztljziik# FC =>>=:% Bcc zfglts zasaz}ad% Ei ~bzt im tlfs bztfoca iz

    jv tla B`azfobe Oiccaga im Olast lvsfofbes# ??>> Dqedaa Zibd#^lvsfofbes% Ft lbs jaae ~qjcfslad `ietlcv sfeoa 26?1% Oi~vzfglt :>>2OLA_T fs tla immfofbc hiqzebc im tla B`azfobe Oiccaga im Olast

    Oi~vzfglt :>>2 B`azfobe Oiccaga im Olast ^lvsfofbesjv gqast ie Bqgqst :6# :>>6www%olasthiqzebc%izgDiwecibdad mzi`

    http://www.chestjournal.org/content/120/4/1347.full.htmlhttp://www.chestjournal.org/content/120/4/1347.full.htmlhttp://www.chestjournal.org/content/120/4/1347.full.htmlhttp://www.chestjournal.org/site/misc/reprints.xhtmlhttp://www.chestjournal.org/site/misc/reprints.xhtmlhttp://www.chestjournal.org/http://www.chestjournal.org/http://www.chestjournal.org/http://www.chestjournal.org/site/misc/reprints.xhtmlhttp://www.chestjournal.org/content/120/4/1347.full.html
  • 8/9/2019 Acute Respiratory Distress Syndrome 4

    2/23

    Tzabt`aet im BZD_(

    Ziv G% Jziwaz# @D; Cizzbfea J% Wbza# @D; V}as Jaztlfbq`a# @D; bed@folbac B% @bttlbv# @D# MOO^

    F`~zi}ad qedazstbedfeg im tla ~btligaeasfs im boqta cqeg fehqzv ,BCF&)BZD_ lbs cad tif`~iztbet bd}beoas fe tla tzabt`aet im BCF)BZD_# ~bztfoqcbzcv fe tla bzab im }aetfcbtiz-bssiofbtad cqeg fehqzv% _tbedbzd sq~~iztf}a obza miz BCF)BZD_ sliqcd eiw feocqda b ~zitaotf}a}aetfcbtizv stzbtagv wftl ciw tfdbc }icq`a }aetfcbtfie jv tla ~zitioic da}aci~ad jv tla EbtfiebcFestftqtas im Labctl BZD_ Eatwizk% Mqztlaz zamfea`aets im tla ~zitioic miz `aolbefobc}aetfcbtfie wfcc iooqz bs oqzzaet bed mqtqza ocfefobc tzfbcs bza oi`~catad% Fe bddftfie# ei}ac `idasim `aolbefobc }aetfcbtfie bza jafeg stqdfad bed `bv bqg`aet stbedbzd tlazb~v fe tla mqtqza%

    Bctliqgl zasqcts im betf-femcb``btizv stzbtagfas lb}a jaae dfsb~~ifetfeg fe ocfefobc tzfbcs# mqztlaztzfbcs bza qedazwbv ti tast tla ammfobov im cbta oiztfoistazifds bed itlaz b~~zibolas ti `idqcbtfieim femcb``btfie fe BCF)BZD_% ,OLA_T :>>2; 2:>82?472?=7&

    Kav wizds8 boqta cqeg fehqzv; `aolbefobc }aetfcbtfie; ~qc`iebzv ada`b; }aetfcbtiz-bssiofbtad cqeg fehqzv

    Bjjza}fbtfies8 BCF boqta cqeg fehqzv; B^Z] bfzwbv ~zassqza-zacabsa }aetfcbtfie; AOoi:Z a|tzboiz~izabc

    obzjie dfi|fda za i}bc; AO@I a|tzboiz~izabc `a`jzbea i|vgaebtfie; Mfi: mzbotfie im fes~fzad i|vgae;LM] lfgl-mzarqaeov }aetfcbtfie; F8A zbtfi im tla dqzbtfie im fes~fzbtfie ti tla dqzbtfie im a|~fzbtfie;FC fetazcaqkfe; F@^Z] fetaz fttaet `bedbtizv ~zassqza-zacabsa }aetfcbtfie; FZ] fe}azsa-zbtfi }aetfcbtfie;CM^^] ciw-mzarqaeov ~isftf}a-~zassqza }aetfcbtfie; EFL Ebtfiebc Festftqtas im Labctl; EF^^] eiefe}bsf}a~isftf}a-~zassqza }aetfcbtfie; EI eftzfo i|fda; ^AA^ ~isftf}a aed-a|~fzbtizv ~zassqza; ^_J ~zitaotad s~aof`aejzqslfeg; TGF tzbolabc gbs fesqmmcbtfie; TEM tq`iz eaozisfs mbotiz

    Tla svedzi`a im boqta zas~fzbtizv dfstzass febdqcts wbs mfzst dasozfjad fe 26=7%2 Qetfc za-

    oaetcv# `ist za~iztad `iztbcftv zbtas a|oaadad 1>!%Liwa}az# tla `iztbcftv mzi` boqta cqeg fehqzv ,BCF&bed BZD_ ,BCF)BZD_& lbs daozabsad bs cbjizbtizvbed ocfefobc stqdfas lb}a ~zi}fdad eaw a}fdaeoa tif`~zi}a tlazb~aqtfo stzbtagfas% Tlfs bztfoca za}fawstla zasqcts im tlasa stqdfas bed sq``bzfxas oqzzaetzaoi``aedbtfies miz stbedbzd sq~~iztf}a tlazb~v%Eaw tzabt`aet stzbtagfas tlbt bza jafeg a}bcqbtad feiegifeg ocfefobc tzfbcs bza bcsi za}fawad% Femiz`btfiezagbzdfeg ocfefobc damfeftfies# a~fda ficigv# bed~btligaeasfs im BCF)BZD_ fs b}bfcbjca fe itlazza}faws%:7

    _tbedbzd _q~~iztf}a Tlazb~v

    _tbedbzd sq~~iztf}a tlazb~v miz BCF)BZD_ fsdfzaotad tiwbzd fdaetfmfobtfie bed `bebga`aet im

    ~qc`iebzv bed eie~qc`iebzv izgbe dvsmqeotfie%

    Tzabt`aet im tla Feoftfeg Ocfefobc Dfsizdaz fe^btfaets Wftl BZD_

    Fdaetfmfobtfie bed tzabt`aet im tla feoftfeg ocfefobcdfsizdaz fs be f`~iztbet bs~aot im tla feftfbc `bebga-`aet im b ~btfaet wftl BCF)BZD_% Tla `ist oi`-`ie dfsabsa ~zioassas bssiofbtad wftl BCF feocqdasa~sfs# ~eaq`iefb# bs~fzbtfie im gbstzfo oietaets#tzbq`b# `qctf~ca tzbesmqsfies# bed fsola`fb za~azmq-sfie ,Tbjca 2&% Fe si`a ofzoq`stbeoas# tla qedazcv-feg obqsa im BCF obe ja tzabtad dfzaotcv% Miz a|b`-~ca# ~btfaets wftl ~eaq`iefb mzi` jbotazfbc izi~~iztqefstfo femaotfies `bv zas~ied ti s~aofmfobetf`fozijfbc tlazb~v% B obzamqc sabzol miz b tzabt-bjca obqsa im ~qc`iebzv femaotfie# sqol bs jbotazfbc~eaq`iefb# btv~fobc ~eaq`iefb mzi` @voi~cbs`biz Cagfieaccb# iz be i~~iztqefstfo femaotfie mzi`mqegf# tqjazoqcisfs# iz ^eaq`iovstfs obzfeff fs wbz-zbetad% Tla dfbgeistfo a}bcqbtfie sliqcd ja gqfdadjv tla ocfefobc lfstizv% Fe itlaz ~btfaets# be femaotfiqsobqsa im BCF `bv ja zacbtad ti be a|tzb~qc`iebzvsfta im femaotfie# sqol bs tla jfcfbzv tzbot# ~azftieabcob}ftv# iz qzfebzv tzbot% Tla dfbgeisfs im fetzb-bj-

    (Mzi` Hiles Li~kfes Qef}azsftv ,Dz% Jziwaz Jbctf`iza# @D;tla Qef}azsftv im @ietzabc ,Dz% Jaztlfbq`a @ietzabc# Obebdb;bed tla Obzdfi}bsoqcbz Zasabzol Festftqta ,Dzs% Wbza bed @bt-tlbv Tla Qef}azsftv im Obcfmizefb bt _be Mzbeofsoi# _be Mzbe-ofsoi# OB%Tlfs bztfoca wbs sq~~iztad jv Ebtfiebc Festftqtas im Labctl gzbetsZI2-LC1216 ,Dz%@bttlbv EI2-LZ4=>=? ,Dz% Jziwaz bed tla @adfobc Za-sabzol Oiqeofc im Obebdb ,Dz% Jaztlfbq a&%@beqsozf~t zaoaf}ad Hqea :# :>>>; za}fsfie booa~tad Hbeqbzv ?>#:>>2%Oizzas~iedaeoa ti8 @folbac B% @bttlbv# @D# MOO^# @immfttLis~ftbc# Zii` @-627# Qef}azsftv im Obcfmizefb# 1>1 ^bzebssqs

    B}a# _be Mzbeofsoi# OB 6424?->=:4; a-`bfc8 ``bttNftsb%qosm%adq

    OLA_T ) 2:> ) 4 ) IOTIJAZ# :>>2 2?47

    Oi~vzfglt :>>2 B`azfobe Oiccaga im Olast ^lvsfofbesjv gqast ie Bqgqst :6# :>>6www%olasthiqzebc%izgDiwecibdad mzi`

    http://www.chestjournal.org/http://www.chestjournal.org/http://www.chestjournal.org/
  • 8/9/2019 Acute Respiratory Distress Syndrome 4

    3/23

    di`febc sa~sfs sliqcd ja oiesfdazad abzcv fe ~btfaetswftl sa~sfs svedzi`a bed BCF im qeoaztbfe atficigv%^zi`~t sqzgfobc fetaz}aetfie ti azbdfobta be fetzb-bjdi`febc siqzoa im sa~sfs fs bssiofbtad wftl jattaziqtoi`as%< Mbotizs bssiofbtad wftl ~isftf}a mfedfegsbt a|~cizbtizv cb~bziti`v feocqda ijhaotf}a mfedfegsie ~lvsfobc a|b`febtfie bed qctzbsiqed# iz OT mfed-fegs sqggastf}a im be fetzb-bjdi`febc mioqs im femao-tfie%6 Bctliqgl tla ~zigeisfs miz zaoi}azv mzi`sa~sfs-fedqoad cqeg fehqzv fs wizsa tlbe mzi` bev

    itlaz obqsa#2>#22

    s~aofmfo `adfobc bed sqzgfobc tzabt-`aet im tla ~qc`iebzv iz a|tzb~qc`iebzv siqzoa imsa~sfs fs fedfobtad ti aelbeoa tla olbeoa im sqz}f}bc%Fe `bev BCF)BZD_ ~btfaets# tla fesqct tlbt obqsadcqeg fehqzv# sqol bs bs~fzbtfie iz `qctf~ca tzbesmq-sfies# obeeit ja tzabtad a|oa~t ti ~za}aet zaoqz-zaeoa bed ~zi}fda i~tf`bc sq~~iztf}a obza bs iqt-cfead jaciw%

    @aolbefobc ]aetfcbtfie

    Fe `bev BCF)BZD_ ~btfaets# fetzb~qc`iebzvslqet bed }aetfcbtfie-~azmqsfie f`jbcbeoas obqsacfma-tlzabtaefeg lv~i|a`fb% @izai}az# lfgl wizk imjzabtlfeg mzi` feozabsad bc}aicbz dabd s~boa bedzadqoad zas~fzbtizv svsta` oi`~cfbeoa `bv obqsa }aetfcbtizv mbfcqza wftl lv~azob~efb bed zas~fzbtizvbofdisfs% Tla `bfestbv im sq~~iztf}a obza im BCF)BZD_ fs `aolbefobc }aetfcbtfie%2: Jv stbjfcfxfegzas~fzbtfie# `aolbefobc }aetfcbtfie bcciws tf`a mizbd`fefstzbtfie im tzabt`aet miz tla qedazcvfeg obqsaim BCF)BZD_ ,ag# femaotfie& bed miz tla a}icqtfie imebtqzbc labcfeg ~zioassas% Bztazfbc i|vgaebtfie obeja sq~~iztad jv zbfsfeg tla mzbotfie im fes~fzadi|vgae ,Mfi:& bed b~~cvfeg ~isftf}a aed-a|~fzbtizv

    ~zassqza ,^AA^&% ]aetfcbtfie obe ja sq~~iztad wftlfetaz`fttaet ~isftf}a bfzwbv ~zassqza% Tlfs saotfiebddzassas b~~zibolas ti `aolbefobc }aetfcbtfie tlbtbza oi``iecv qsad bed booa~tad bs stbedbzd sq~-~iztf}a obza fe ~btfaets wftl BCF)BZD_% @aolbefobc}aetfcbtfie b~~zibolas tlbt bza eit fe oi``ie qsa izlb}a eit vat jaae ~zi}ae ti ja jaeamfofbc bzaza}fawad fe tla sqjsarqaet saotfie ie ^itaetfbcEaw Tzabt`aet _tzbtagfas%

    Cqeg-^zitaotf}a ]aetfcbtfie Wftl _`bcc Tfdbc ]ic-q`as8 Iea im tla ocfefobc lbcc`bzks im BCF)BZD_ fsdaozabsad zas~fzbtizv svsta` oi`~cfbeoa%2? Tlfs fsobqsad jv btacaotbsfs bed mciidfeg im bc}aicf bed jvfeozabsad sqzmboa taesfie bt bfz-mcqfd fetazmboas%Olast zbdfigzb~ls mzarqaetcv sqggast tlbt tla dfs-absa fs dfstzfjqtad li`igaeaiqscv tlziqgliqt tlacqegs% Liwa}az# OT f`bgas bed ~lvsficigfo stqdfasda`iestzbta tlbt tla cqeg fs bmmaotad fe b ~btolv#latazigaeaiqs beeaz%24#21 Tla cqegs im BCF)BZD_~btfaets obe ja `idacad bs oiesfstfeg im tlzaadfmmazaet oi`~bzt`aets8 ,2& zagfies im sa}aza femcb`-`btfie# bc}aicbz mfccfeg# bed btacaotbsfs fe wlfol cfttcacqeg }icq`a obe ja zaozqftad wftl bfzwbv ~zassqzastlbt bza tzbdftfiebccv oiesfdazad sbma; ,:& zagfieswftl eiz`bc oi`~cfbeoa bed bazbtfie# b~~abzfeg tija qefe}ic}ad wftl dfsabsa; bed ,?& fetaz`adfbtazagfies fe wlfol bc}aicbz oiccb~sa bed mciidfeg bzab~~bzaet jqt wlaza bazbtfie obe ja zastizad jvzbfsfeg bfzwbv ~zassqzas wftlfe b sbma zbega%

    Wlae tzbdftfiebc tfdbc }icq`as im 2> ti 21 `C)kgbza qsad fe ~btfaets wftl BCF)BZD_ zaoaf}feg `a-olbefobc }aetfcbtfie# tla zasqctfeg bfzwbv ~zassqzasbza mzarqaetcv aca}btad# zamcaotfeg i}azdfstaetfie imtla cass-bmmaotad cqeg zagfies% Fe `bev cbjizbtizva|~azf`aets#2=:2 }aetfcbtfie wftl lfgl bfzwbv ~zas-sqzas obqsad feozabsad ~qc`iebzv }bsoqcbz ~az`a-bjfcftv# boqta femcb``btfie# bc}aicbz la`izzlbga#fetzb~qc`iebzv slqet# bed dfmmqsa zbdfigzb~lfo femfc-tzbtas% @ist im tlasa stqdfas waza oiedqotad feeiz`bc bef`bcs wftl }azv cbzga tfdbc }icq`as# bedtlqs waza eit dfzaotcv b~~cfobjca ti tla a|~azfaeoa fe~btfaets wftl BCF)BZD_% Liwa}az# zbts wftl a|~az-f`aetbc BCF lbd sfgefmfobetcv cass ada`b wlae za-oaf}feg }aetfcbtfie wftl s`bccaz tfdbc }icq`as%::

    @izai}az# bctliqgl tla tfdbc }icq`as tlbt obqsadfehqzv fe tla bef bc `idacs waza b~~zi|f`btacvtlzaa ti miqz tf`as gzabtaz tlbe tlisa qsad jv `istocfefofbes# `ist im tla tfdbc }icq`a fe BCF)BZD_~btfaets fs dfzaotad ti b zacbtf}acv s`bcc b`iqet imbazbtad cqeg% Tlasa stqdfas sqggast tlbt fe si`a~btfaets wftl BCF)BZD_# tzbdftfiebc b~~zibolas ti`aolbefobc }aetfcbtfie a|boazjbta iz ~az~atqbta cqegfehqzv jv obqsfeg a|oassf}a stzatol im bazbtad cqegzagfies dqzfeg fes~fzbtfie%

    ]aetfcbtfie wftl s`bcc tfdbc }icq`as bed cf`ftad

    Tbjca 2 Feoftfeg Ocfefobc Dfsizdazs Bssiofbtad WftlBCF bed BZD_

    ^qc`iebzv dfsizdazs^eaq`iefb

    JbotazfbcMqegbc^bzbsftfo

    ]fzbc

    Bs~fzbtfie im gbstzfo oietaets^qc`iebzv oietqsfieMbt a`jicfEabz-dziwefegFelbcbtfiebc fehqzvZa~azmqsfie ~qc`iebzv ada`b bmtaz cqeg tzbes~cbetbtfie

    A|tzb~qc`iebzv dfsizdazs_a~sfsTzbq`b wftl `qctf~ca tzbesmqsfiesObzdfi~qc`iebzv jv~bssDzqg i}azdisaBoqta ~beozabtftfsJciid ~zidqot tzbesmqsfies

    2?4< Za}faws

    Oi~vzfglt :>>2 B`azfobe Oiccaga im Olast ^lvsfofbesjv gqast ie Bqgqst :6# :>>6www%olasthiqzebc%izgDiwecibdad mzi`

    http://www.chestjournal.org/http://www.chestjournal.org/http://www.chestjournal.org/
  • 8/9/2019 Acute Respiratory Distress Syndrome 4

    4/23

    bfzwbv ~zassqzas obe zadqoa }aetfcbtiz-bssiofbtadcqeg fehqzv mzi` i}azdfstaetfie% Liwa}az# s`bcc tfdbc }icq`a }aetfcbtfie `bv obqsa oi`~cfobtfies mzi`boqta zas~fzbtizv bofdisfs%:?:= Tlqs# ti bolfa}a tlajaeamfofbc ammaot im tlfs b~~zibol zarqfzas si`aoi`~zi`fsa im tzbdftfiebc ijhaotf}as wftl zas~aot tigbs a|olbega bed bofd-jbsa jbcbeoa% Ocfefobc a}f-daeoa sq~~iztfeg tlfs stzbtagv ob`a feftfbccv mzi`twi ijsaz}btfiebc stqdfas:4#:1 fe wlfol `iztbcftv zbtasim BZD_ ~btfaets tzabtad wftl s`bcc tfdbc }icq`asbed ~az`fssf}a lv~azob~efb waza oi`~bzad ti `iz-tbcftv zbtas ~zadfotad mzi` lfstizfobc oietzic sqjhaots%Tlasa stqdfas waza eit oieocqsf}a jaobqsa tlavcbokad oieoqzzaet oietzic gziq~s tzabtad wftl btzbdftfiebc }aetfcbtfie b~~zibol%

    Tlzaa s`bcc ~zis~aotf}a# zbedi`fxad tzfbcs:7:6 imtzbdftfiebc }s ciwaz tfdbc }icq`a }aetfcbtfie fe ~b-tfaets wftl iz bt zfsk miz BCF)BZD_ dfd eit da`ie-stzbta jaeamfofbc ammaots im tla ciwaz tfdbc }icq`ab~~zibol% Liwa}az# `iztbcftv wbs zadqoad sqjstbe-tfbccv mzi` 4>! ,tzbdftfiebc stzbtagv& ti ?2! ,ciwaztfdbc }icq`a stzbtagv& fe b cbzgaz tzfbc jv tla EbtfiebcFestftqtas im Labctl ,EFL& BZD_ Eatwizk?> ,Mfg 2&%Tlaza waza bcsi `iza }aetfcbtiz-mzaa bed izgbembfcqza-mzaa dbvs fe ~btfaets wli zaoaf}ad tla ciwaztfdbc }icq`a stzbtagv% Fe tla ciwaz tfdbc }icq`agziq~# tla tbzgat tfdbc }icq`a wbs = `C)kg im~zadfotad jidv wafglt% Tlfs wbs zadqoad mqztlaz ti1 `C)kg iz 4 `C)kg fm eaoassbzv ti `bfetbfe tlaaed-fes~fzbtizv ~cbtabq ~zassqza ,>%1-s ~bqsa& ?>o` L:I% Be f`~iztbet dfmmazaeoa jatwaae tlaBZD_ Eatwizk tzfbc bed tla ~za}fiqs stqdfas fs tlbttla tfdbc }icq`as fe tla ciwaz tfdbc }icq`a stzbtagvim tla BZD_ Eatwizk tzfbc waza s`bccaz% @bebga-

    `aet im bofdisfs wbs bcsi dfmmazaet fe tla BZD_Eatwizk tzfbc#?> wlfol zarqfzad lfgl zas~fzbtizvzbtas bed bcciwad sidfq` jfobzjiebta femqsfie tioi`~aesbta miz zas~fzbtizv bofdisfs%

    Tla BZD_ Eatwizk tzfbc?> a|ocqdad ~btfaets wftlaca}btad fetzbozbefbc ~zassqza bed wftl sfokca la`igci-jfe jaobqsa lv~azob~efb bed bofdisfs oiqcd lb}a bd-}azsa ammaots fe tlasa oiedftfies% Liwa}az# tla ciwaztfdbc }icq`a b~~zibol fs zaoi``aedad miz `ist itlaz~btfaets wftl BCF)BZD_% Tla oi`~cata `atlidicigvmiz tla tzfbc ~zioadqzas fs b}bfcbjca bt www%bzdseat%izgbed mzi` tla Ebtfiebc Bq|fcfbzv ^qjcfobtfies _az}foa,o)i @fozimfola ^qjcfobtfies# :4< La ~stabd Tqze-~fka# Wast La`~stabd# EV 2211:; dioq`aet >114:&%Tla ciwaz tfdbc }icq`a stzbtagv fs sq `bzfxad fe Tbjca:% A|oa~t miz tla ciwaz tfdbc }icq`as wftl ~az`fssf}alv~azob~efb# tlfs b~~zibol fs oiesfstaet wftl ~za}fiqscvbooa~tad stbedbzd sq~~iztf}a tzabt`aet miz BCF)BZD_% Wftl tla sqjstbetfbc f`~zi}a`aets fe f`~iz-tbet ocfefobc iqtoi`as da iestzbtad fe tla BZD_Eatwizk tzfbc#?> tla ciwaz tfdbc }icq`a stzbtagv `bveiw ja oiesfdazad stbedbzd sq~~iztf}a tzabt`aet miz~btfaets wftl BCF)BZD_# qetfc beitlaz `aolbefobc}aetfcbtfie stzbtagv fs da`iestzbtad ti ja sq~azfiz%

    _q~~izt im Bztazfbc I|vgaebtfie ,^AA^ }s MFI:&8

    @ist BCF)BZD_ ~btfaets zarqfza sq~~izt miz bztazfbci|vgaebtfie wftl b oi`jfebtfie im feozabsad Mfi:bed ^AA^% Jitl im tlasa tzabt`aets lb}a ~itaetfbcbd}azsa ammaots tlbt `qst ja obzamqccv oiesfdazad fefedf}fdqbc ~btfaets% Fe cbjizbtizv bef`bcs# lfgl ca}acs

    im fes~fzad i|vgae obqsa ~lvsficigfo bed ~btlicigfoolbegas tlbt bza sf`fcbz ti itlaz miz`s im BCF%?2?1

    Mfgqza 2% ^zi~iztfies im ~btfaets sqz}f}feg bed bolfa}feg dfs-olbzga li`a fe tzbdftfiebc ,2: `C)kg& bed ciwaz tfdbc }icq`a ,=`C)kg& stqdv gziq~s% @iztbcftv jamiza dfsolbzga li`a wftlqebssfstad jzabtlfeg wbs sfgefmfobetcv ciwaz fe tla ciwaz tfdbc

    }icq`a stqdv gziq~ ,?6%!&% Za~zfetad wftl ~az`fssfieim tla BZD_ Eatwizk%?>

    Tbjca :EFL BZD_ Eatwizk Ciwaz Tfdbc ]icq`a]aetfcbtfie miz BCF)BZD_ ^zitioic _q``bzv(

    ]bzfbjcas ^zitioic

    ]aetfcbtiz `ida ]icq`a bssfst-oietzicTfdbc }icq`a = `C)kg ~zadfotad jidv wafglt^cbtabq ~zassqza ?> o` L:I

    ]aetfcbtfie sat zbta)~L gibc

    =?1)`fe# bdhqstad ti bolfa}a bztazfbc~L 7%?> fm ~issfjca

    Fes~fzbtizv mciw# F8A Bdhqst mciw ti bolfa}a F8A im 28228?I|vgaebtfie gibc 11 ^bi:`` Lg iz

    %?)1# >%4)1# >%4)%1)%1)2># >%=)2>#>%7)2># >%7)2:# >%7)24# >%%6)24#>%6)2=# >%6)2)2)::# 2%>):4

    Wabefeg Btta`~ts ti wabe jv ~zassqza sq~~iztzarqfzad wlae Mfi:)^AA^ %4>) ,:%? [lafglt fe

    feolas =>P& iz 1> ,>%62 [lafglt fe oaetf atazs 21:%4P&;~zadfotad jidv wafglt miz ma`bca sqjhaots 4%1 ,:%? [lafglt fefeolas =>P& iz 4%1 ,>%62 [lafglt fe oaetf`atazs 21:%4P&%

    Mqztlaz feozabsas fe ^AA^ ti ?4 o` L:I bcciwad jqt eit zarqfzad%

    OLA_T ) 2:> ) 4 ) IOTIJAZ# :>>2 2?46

    Oi~vzfglt :>>2 B`azfobe Oiccaga im Olast ^lvsfofbesjv gqast ie Bqgqst :6# :>>6www%olasthiqzebc%izgDiwecibdad mzi`

    http://www.chestjournal.org/http://www.chestjournal.org/http://www.chestjournal.org/
  • 8/9/2019 Acute Respiratory Distress Syndrome 4

    5/23

    Fe lq`bes# ei dataotbjca i|vgae ti|foftv iooqzzad feeiz`bc sqjhaots wlae tla Mfi: wbs 1>!#?= jqtf`~bfzad gbs a|olbega wbs b~~bzaet bmtaz jzabtlfeg2>>! i|vgae bt sab ca}ac miz b~~zi|f`btacv 4> l%?7

    Dfsabsad cqegs `bv ja `iza sqsoa~tfjca ti fehqzvmzi` `idazbta lv~azi|fb%?< Liwa}az# feftfbc a|~i-sqzas ti b `idazbta Mfi: iz ti aediti|fe `bv oiemazsi`a ~zitaotfie mzi` lv~azi|fo cqeg fehqzv%?64:

    Bcsi# ~cbs`b ~zitafes tlbt cabk feti tla ~qc`iebzvbfzs~boas `bv lb}a betfi|fdbet ~zi~aztfas%4? Bc-tliqgl tla zacbtfieslf~ im Mfi: ti i|vgae-fedqoadcqeg fehqzv lbs eit jaae ocabzcv damfead fe BCF)BZD_ ~btfaets# be Mfi: >%= fs qsqbccv oiesfdazadti ja sbma%44

    ^AA^ zadqoas fetzb~qc`iebzv slqet bed f`-~zi}as bztazfbc i|vgaebtfie#2#2: tlqs bcciwfeg bda-rqbta bztazfbc i|vgaebtfie bt b ciwaz Mfi:# wlfol`bv zadqoa ~qc`iebzv i|vgae ti|foftv% Liwa}az#bd}azsa ammaots im ^AA^ feocqda daozabsad obzdfboiqt~qt#4112 feozabsad ~qc iebzv ada`b miz`b-tfie#1:14 feozabsad dabd s~boa# feozabsad zasfstbeoaim tla jzieolfbc ofzoqcbtfie#11 bed feozabsad cqeg }icq`a bed stzatol dqzfeg fes~fzbtfie# wlfol `bvobqsa mqztlaz cqeg fehqzv iz jbzitzbq`b%26#:>#1= Tlasabd}azsa ammaots im ^AA^ `bv ja `iza ~zieiqeoad fe~btfaets wftl dfzaot cqeg fehqzv ,~eaq`iefb bedbs~fzbtfie ~eaq`ieftfs fe wli` ^AA^ fs eit bsammaotf}a bt zaozqftfeg bfzs~boas% Tlqs# jaeamfofbcammaots im ^AA^ ie bztazfbc i|vgaebtfie `qst ja wafglad obzamqccv fe zacbtfie ti ~itaetfbc bd}azsaammaots% _i`a fe}astfgbtizs lb}a sqggastad qsfeglfglaz ^AA^ ti `fef`fxa Mfi:#17 iz ti ~zitaot tlacqeg mzi` fehqzfiqs `aolbefobc mizoas tlbt iooqzmzi` }aetfcbtfie wftl btacaotbsfs bt aed-a|~fzbtfie%1 jqt ~zas-sqza-ovocad `idas obe ~zi}fda sf fcbz ca}acs im}aetfcbtizv sq~~izt% Fes~fzbtizv feoza`aets fe tzbes-`qzbc bc}aicbz ~zassqza bed }icq`a }bzv dfzaotcv wftl abol itlaz booizdfeg ti tla ~zassqza-}icq`aolbzbotazfstfos im tla cqeg# zagbzdcass im }aetfcbtiz`ida% Laeoa# miz b gf}ae tfdbc }icq`a# tlaza fs eibd}betbga iz dfsbd}betbga im ~zassqza-oietziccad }s

    }icq`a-ovocad `idas fe zacbtfie ti zfsks im jbzi-tzbq`b iz stzatol-fedqoad cqeg fehqzv% _i`a lb}asqggastad tlbt tla zb~fd fes~fzbtizv bfzmciw tlbtiooqzs wftl ~zassqza-oietziccad `idas fs `iza mb-}izbjca miz gbs a|olbega% Liwa}az# tlaza waza eidfmmazaeoas fe ^bi: iz ^boi: wlae BCF)BZD_ ~b-tfaets zaoaf}ad }aetfcbtfie wftl }icq`a-ovocad }s

    ~zassqza-oietziccad `idas bt oiestbet tfdbc }icq`a#aed-a|~fzbtizv bc}aicbz ~zassqza# bed zbtfi im tladqzbtfie im fes~fzbtfie ti tla dqzbtfie im a|~fzbtfie,F8A&%=2#=: _i`a ~btfaets `bv ja `iza oi`miztbjcazaoaf}feg ~zassqza-sq~~izt }aetfcbtfie# as~aofbccvwlae tlaza bza sqjstbetfbc zas~fzbtizv ammizts% Liw-a}az# }icq`a-ovocad `idas ~zi}fda gzabtaz oietzici}az tfdbc }icq`a# wlfol fs be f`~iztbet dataz`febetim }aetfcbtiz-bssiofbtad cqeg fehqzv%1=

    _qmmfofaet gbs a|olbega obe qsqbccv ja bolfa}adwftl oie}aetfiebc `aolbefobc }aetfcbtfie% Liwa}az#tlfs `bv eit ja ~issfjca fe si`a BCF)BZD_ ~btfaetswftliqt obqsfeg }aetfcbtiz-bssiofbtad cqeg fehqzv izi|vgae ti|foftv% Eq`aziqs bddftfiebc tzabt`aets tif`~zi}a gbs a|olbega iz zadqoa }aetfcbtfie iz lv-~azi|fb-bssiofbtad cqeg fehqzv bza oqzzaetcv qedazfe}astfgbtfie% _i`a eaw tzabt`aets qtfcfxa ei}ac`atlids im `aolbefobc }aetfcbtfie% Itlazs qtfcfxa~lbz`boicigfo `aolbefs`s ti f`~zi}a gbs a|olbegabed cqeg `aolbefos% Tlasa b~~zibolas bza dfsoqssadfe tla sqjsarqaet saotfie ie ^itaetfbc Eaw Tzabt-`aets _tzbtagfas%

    La`idveb`fo @bebga`aet8 Mcqfds# ]bsi~zassizs#

    bed I|vgae Dacf}azvI~tf`bc mcqfd `bebga`aet fe ~btfaets wftl BCF)

    BZD_ fs b oietzi}azsfbc fssqa% _qjstbetfbc dbtb mzi`bef`bc a|~azf`aetbtfie sqggast tlbt mcqfd zastzfotfie`bv zadqoa ~qc iebzv ada`b fe ~btfaets wftlfeozabsad ~qc`iebzv }bsoqcbz ~az`abjfcftv# bs feBCF)BZD_% Liwa}az# itlaz a|~azf aetbc dbtb=?#=4

    sqggast tlbt BCF)BZD_ ~btfaets `bv jaeamft mzi` bla`idveb fo `bebga`aet stzbtagv tlbt feozabsasi|vgae dacf}azv# wlfol `bv zarqfza feozabsad }bsoq-cbz }icq`a%

    Ada`b miz`btfie iooqzs bt ciwaz ~qc`iebzv ob~-fccbzv ~zassqzas wlae ~qc`iebzv }bsoqcbz ~az`abjfc-ftv fs feozabsad%=?=7 Tla a|~azf aetbc dbtb tlbtsq~~izt mcqfd zastzfotfie fe ~btfaets wftl BCF bzasq~~iztad jv si`a ijsaz}btfiebc ocfefobc stqdfas%Tzabt`aet im BZD_ ~btfaets wftl dfqzatfos iz dfbc- vsfs lbs jaae sliwe=< ti f`~zi}a i|vgaebtfie bedzas~fzbtizv svsta` cqeg oi`~cfbeoa% Iea stqdv=6

    za~iztad tlbt sqz}f}bc fe BZD_ ~btfaets wbs zacbtadti eagbtf}a mcqfd jbcbeoa# wlfca beitlaz stqdv7>

    za~iztad tlbt sqz}f}bc wbs gzabtaz fe ~btfaets fe wli` tlaza wbs b :1! zadqotfie fe ~qc`iebzvbztazfbc wadga ~zassqza% Fe b tlfzd stqdv#72 ~btfaets

    2?1> Za}faws

    Oi~vzfglt :>>2 B`azfobe Oiccaga im Olast ^lvsfofbesjv gqast ie Bqgqst :6# :>>6www%olasthiqzebc%izgDiwecibdad mzi`

    http://www.chestjournal.org/http://www.chestjournal.org/http://www.chestjournal.org/
  • 8/9/2019 Acute Respiratory Distress Syndrome 4

    6/23

    wli gbfead 2 C im mcqfd bmtaz ?= l im jafegzaozqftad feti b stqdv im BCF lbd b jattaz sqz}f}bczbta ,74!& tlbe tla itlazs ,1>!&% Liwa}az# tlasaijsaz}btfies di eit ~zi}a tlbt mcqfd zastzfotfie fsammfobofiqs% Mcqfd booq`qcbtfie `bv lb}a jaae b`bzkaz im tla sa}azftv im svsta`fo bed ~qc`iebzvob~fccbzv ~az`abjfcftv%

    Tlfs fssqa wbs bddzassad fe b ~zis~aotf}a# zbedi`-fxad tzfbc fe wlfol dfqzasfs# mcqfd zastzfotfie# bedla`idveb`fo `bebga`aet waza dfzaotad aftlaz jv`absqzfeg tla a|tzb}bsoqcbz cqeg wbtaz qsfeg b diq-jca-fedfobtfie taolefrqa72#7: iz wftl stbedbzd ocfefobcfemiz`btfie# wlfol feocqdad ~qc`iebzv bztazfbc obtl-ataz dbtb%7: Bmtaz :4 l im tzabt`aet# cqeg wbtaz wbssfgefmfobetcv ciwaz fe tla a|tzb}bsoqcbz cqeg wbtaz`bebga`aet gziq~%7: Tlasa ~btfaets bcsi zarqfzad bsliztaz dqzbtfie im `aolbefobc }aetfcbtfie bed bsliztaz stbv fe tla FOQ# jqt sqz}f}bc wbs eit sfgefm-fobetcv dfmmazaet jatwaae tla gziq~s% Mqztlaz`iza#tla stqdv ~i~qcbtfie feocqdad ~btfaets wftl lvdzi-stbtfo ~qc`iebzv ada`b# wli wiqcd ja a|~aotad tijaeamft mzi` bggzassf}a mcqfd zastzfotfie%

    Mcqfd zastzfotfie `bv zadqoa obzdfbo iqt~qt bedtfssqa ~azmqsfie# wlfol oiqcd obqsa iz wizsae eie-~qc`iebzv izgbe dvsmqeotfie% Fe `bev BCF)BZD_~btfaets# dvsmqeotfie im `qctf~ca izgbes bed svs-ta`s iooqzs mzi` b svsta`fo femcb``btizv za-s~iesa%2>#22#7?7= B zacbtad a|~cbebtfie miz `qctf~caizgbe dvsmqeotfie fs tlbt tfssqa i|vgae dacf}azv fsfebdarqbta fe si`a svsta`fo femcb``btizv oiedf-tfies sqol bs sa~sfs iz sa}aza tzbq`b# a}ae wlaeobzdfbo iqt~qt bed i|vgae dacf}azv bza eiz`bc%77#7>2 B`azfobe Oiccaga im Olast ^lvsfofbesjv gqast ie Bqgqst :6# :>>6www%olasthiqzebc%izgDiwecibdad mzi`

    http://www.chestjournal.org/http://www.chestjournal.org/http://www.chestjournal.org/
  • 8/9/2019 Acute Respiratory Distress Syndrome 4

    7/23

    fe ~btfaets wli dfa mzi` BCF%4= Tla obqsa im ~qc-`iebzv bztazfbc lv~aztaesfie fs `qctfmbotizfbc# bed`bv feocqda lv~i|fo }bsioiestzfotfie# dastzqotfiebed)iz ijstzqotfie im tla ~qc`iebzv }bsoqcbz jad#bed lfgl ca}acs im ^AA^%=? Fe si`a ~btfaets# ~qc`i-ebzv bztazfbc lv~aztaesfie obe cabd ti obzdfbo dvs-mqeotfie mzi` zfglt }aetzfoqcbz i}azcibd%=? Fe sa}azbcstqdfas# fe}astfgbtizs lb}a btta`~tad ti f`~zi}aBCF)BZD_ `bebga`aet jv ciwazfeg ~qc`iebzv bz-tazfbc ~zassqza wftl ~qc iebzv }bsidfcbtizs% Miza|b`~ca# lvdzbcbxfea b~~abzs ti ja `iza ammfobofiqsfe feozabsfeg obzdfbo iqt~qt tlbe eftzi~zqssfda wftl-iqt feozabsfeg tla slqet mzbotfie#6= ~zijbjcv jaobqsaft dias eit femcqaeoa lv~i|fo }bsioiestzfotfie%67

    Liwa}az# lvdzbcbxfea lbs eit jaae a}bcqbtad fezbedi`fxad# oietziccad tzfbcs% ^zacf febzv stqdfas6>

    Eftzfo i|fda ,EI& fs b ~iwazmqc aedigaeiqs }bsi-dfcbtiz%2>2#2>: Jaobqsa ft fs zb~fdcv febotf}btad# fts}bsidfcbtizv ammaots bza zastzfotad ti tla jciid }assacsbt tla sfta im gaeazbtfie iz bd`fefstzbtfie% EIfelbcbtfie dfcbtas ~qc`iebzv }assacs ~azmqsfeg baz-btad cqeg qefts# df}aztfeg jciid mciw mzi` ~iizcv}aetfcbtad iz slqet zagfies% Jaobqsa im tlasa ~lbz-`boicigfo bed ~lvsficigfo ammaots# gbsaiqs EI fs~itaetfbccv be fdabc bgaet ti tzabt ~qc`iebzv lv~az-taesfie bed sa}aza lv~i|a`fb fe BCF)BZD_ ~b-tfaets% Aeoiqzbgfeg zasqcts fe si`a bef bc `id-acs2>?2>1 cad ti tla a}bcqbtfie im tla tlazb~aqtfo~itaetfbc im EI fe BCF)BZD_ ~btaets% Fe 6 im 2>oiesaoqtf}a BCF)BZD_ ~btfaets# felbcad EI bt boieoaetzbtfie im 2< ~~` zadqoad `abe ~qc`iebzvbztazv ~zassqza mzi` b `abe im ?7 ti ?> `` Lg% Tlfs wbs bssiofbtad wftl b daozabsa fe fetzb~qc`iebzvslqet mzi` ?= ti ?2! bed be feozabsa fe ^bi:)Mfi:im 47%2>= F`~iztbet ocfefobc iqtoi`as waza eit bs-sassad fe tlfs stqdv% Fe b zbedi`fxad# diqjca-jcfedstqdv im dfmmazaet disas im felbcad EI ,2%:1 ti ~~`& fe BCF)BZD_ ~btfaets# f`~zi}a`aets fe i|v-gaebtfie waza `idast bed eit sqstbfead bmtaz tlamfzst dbv im tzabt`aet%2>7 Fetazastfegcv# tla zasqcts imb zaoaet qe~qjcfslad# ~zis~aotf}a# diqjca-jcfedad#zbedi`fxad Mzaeol ~lbsa FFF stqdv im felbcad EImiz BZD_ fe :>< ~btfaets bcsi da`iestzbtad eiammaot ie `iztbcftv iz tla dqzbtfie im `aolbefobc}aetfcbtfie%2>< Tla zasqcts im tlasa zaoaet tzfbcs sqg-gast tlbt EI wfcc eit jaoi`a ~bzt im stbedbzdtlazb~v miz BCF)BZD_% Tlaza `bv b zica miz EI fesi`a BCF)BZD_ ~btfaets wftl sa}aza zamzbotizvlv~i|a`fb bed ~qc`iebzv bztazfbc lv~aztaesfie%

    @bebga`aet im Femaotfie fe tla BCF)BZD_ ^btfaet

    ^btfaets wftl BCF)BZD_ mzarqaetcv dfa mzi` qe-oietziccad femaotfie% Tla femaotfie `bv lb}a jaaetla feftfbc obqsa im BCF)BZD_# bs fe eie~qc`iebzvsa~sfs ,saa saotfie ie Tzabt`aet im tla FeoftfegOcfefobc Dfsizdaz&% Tlaza fs bcsi b lfgl zfsk imda}aci~feg eisioi`fbc femaotfies# sqol bs ~eaq`i-

    efb bed obtlataz-zacbtad sa~sfs% _feoa qeoietziccadfemaotfie im bev obqsa fs bssiofbtad wftl tla da}ac-i~`aet im `qctf~ca izgbe dvsmqeotfie# b `bhiz ij-haotf}a im stbedbzd sq~~iztf}a obza fe ~btfaets wftlBCF)BZD_ fs ti fdaetfmv# tzabt# bed ~za}aet femao-tfies% Tla za`bfedaz im tlfs saotfie wfcc gf}a bei}az}faw im tla feofdaeoa# dfbgeisfs# tzabt`aet# bed~za}aetfie im eisioi`fbc ~eaq`iefb fe ~btfaets wftl BCF)BZD_% Tla dfbgeisfs bed tzabt aet imitlaz femaotfies sqol bs obtlataz-zacbtad sa~sfs bzaeit sqjstbetfbccv dfmmazaet fe BCF)BZD_ tlbe feitlaz ozftfobccv fcc ~btfaets%

    Bc`ist bcc bs~aots im tla `bebga`aet im eisioi-`fbc ~eaq`iefb fe BCF)BZD_ bza oietzi}azsfbc#feocqdfeg tla feofdaeoa% _a}azbc ~zis~aotf}a stqdfaslb}a btta`~tad ti rqbetfmv tla feofdaeoa ~zis~ao-tf}acv# wftl }bzfad zasqcts% Fe b stqdv2>6 im soladqcadJBC bed ~zitaotad s~aof`ae jzqslfeg ,^_J& fe 2>1~btfaets wftl BCF)BZD_ fe _abttca# WB# tla feof-daeoa im eisioi`fbc ~eaq`iefb dfbgeisad jv rqbe-tftbtf}a JBC iz ^_J oqctqzas wbs iecv 21!% Liw-a}az# betfjfitfo qsa `bv lb}a felfjftad jbotazfbcgziwtl fe oqctqza fe tlfs stqdv# cabdfeg ti qedazdf-bgeisfs im ~eaq`iefb% Twi ~zis~aotf}a Mzaeol stqd-fas im BCF)BZD_ ~btfaets wftl sqs~aotad }aetfcbtiz-bssiofbtad ~eaq`iefb qsad aftlaz JBC22> iz JBCbed ~cqggad tacasoi~feg obtlataz sb`~cfeg222 mizrqbetftbtf}a oqctqzas bed za~iztad b `qol lfglazfeofdaeoa# 11 ti =>!% _b`~cfeg im dfstbc bfzwbvsaozatfies wbs diea ~zfiz ti bev olbegas fe betfjfitfotlazb~v fe jitl stqdfas# ~zijbjcv booiqetfeg miz tla`qol lfglaz vfacd mzi` rqbetftbtf}a oqctqzas% @ist~eaq`iefbs iooqzzad cbta fe tla oiqzsa im BCF)BZD_# bmtaz tla mfzst 7 dbvs% Fetazastfegcv# fe bcctlzaa stqdfas# tla ~zasaeoa iz bjsaeoa im }aetfcbtiz-bssiofbtad ~eaq`iefb lbd cfttca iz ei ammaot ie`iztbcftv%

    Tla dfbgeisfs im eisioi`fbc ~eaq`iefb fe ~b-tfaets wftl BCF)BZD_ fs ~bztfoqcbzcv dfmmfoqct% Tlaqsqbc ocfefobc ozftazfb miz ~eaq`iefb sqol bs b eawzbdfigzb~lfo femfctzbta# ma}az# bed caqkiovtisfs bzaoi``iecv ~zasaet fe BCF)BZD_ ~btfaets# a}ae wlae femaotfie fs bjsaet%22: Liwa}az# `bev BCF)BZD_ ~btfaets lb}a a}fdaeoa im ~eaq`iefb bt bq-ti~sv tlbt wbs eit zaoigefxad jamiza dabtl%22?221

    Oqctqza im aeditzbolabc bs~fzbtas `bv ja `fscabdfeg#sfeoa `ist ~btfaets zaoaf}feg ~ziciegad }aetfcbtizvsq~~izt da}aci~ oiciefxbtfie im tla q~~az bfzwbv bed

    2?1: Za}faws

    Oi~vzfglt :>>2 B`azfobe Oiccaga im Olast ^lvsfofbesjv gqast ie Bqgqst :6# :>>6www%olasthiqzebc%izgDiwecibdad mzi`

    http://www.chestjournal.org/http://www.chestjournal.org/http://www.chestjournal.org/
  • 8/9/2019 Acute Respiratory Distress Syndrome 4

    8/23

    tzbolab% _a}azbc btta`~ts lb}a jaae `bda ti bssasstla }bcqa im jzieolisoi~v wftl ^_J iz cb}bga tisb`~ca dfstbc bfzwbv saozatfies fe ~btfaets wftl sqs-~aotad cqeg femaotfies% Tla zasqcts lb}a jaae }bzf-bjca bed oietzi}azsfbc% Iecv iea stqdv22= lbs bt-ta`~tad ti stqdv tla ammaot im dfmmazaet dfbgeistfotaolefrqas ie `izjfdftv bed `iztbcftv% Fe tlfs tzf-bc#22= 42? ~btfaets zaoaf}feg `aolbefobc }aetfcbtfie wftl sqs~aotad }aetfcbtiz-bssiofbtad ~eaq`iefbwaza zbedi`fxad ti betfjfitfo `bebga`aet stzbta-gfas qsfeg aeditzbolabc bs~fzbtas iz jzieolisoi~vwftl ~zitaotad s~aof`aes% @iztbcftv bt 24 dbvs wbssfgefmfobetcv ciwaz fe tla jzieolisoi~v gziq~% Liw-a}az# iecv b `feizftv im ~btfaets fe tlfs stqdv22= lbdBCF)BZD_# bed `bebga`aet im tla eiefe}bsf}a bz`im tla stqdv `bv lb}a jaae sqji~tf`bc%

    Zagbzdcass im wlatlaz jzieolisoi~fo iz `izaoiesaz}btf}a taolefrqas bza qsad miz dfbgeisfs# tla~zi`~t feftfbtfie im b~~zi~zfbta a`~fzfo tlazb~v wlfca bwbftfeg tla zasqcts im oqctqzas fs ozftfobccvf`~iztbet% A`~fzfo tlazb~v sliqcd ja gqfdad jvciobc ~bttazes im `fozijfbc feofdaeoa bed zasfstbeoa%Ft fs bcsi f`~iztbet ti za`a`jaz tlbt bd`fefstzbtfieim bdarqbta betfjfitfos dias eit bcwbvs f`~zi}aiqtoi`a%224 Ft fs javied tla soi~a im tlfs za}faw ti~zasaet be fe-da~tl dfsoqssfie im betfjfitfo tzabt-`aet miz }aetfcbtiz-bssiofbtad ~eaq`iefb% Tlazabdaz fs zamazzad ti tla zaoaet oiesaesqs stbta`aetmzi` tla B`azfobe Tlizbofo _iofatv miz datbfcadzaoi``aedbtfies%227

    Gf}ae tla lfgl feofdaeoa im eisioi`fbc ~eaq`i-efb fe ~btfaets wftl BCF)BZD_ zaoaf}feg }aetfcbtfie#stzbtagfas miz tla ~za}aetfie im eisioi`fbc ~eaq`i-efb bza be f`~iztbet bzab im fe}astfgbtfie%227 Lbedwbslfeg jv `adfobc ~azsieeac fs im ~zi}ae }bcqa jqtfs imtae i}azciikad% Itlaz bzabs tlbt bza oqzzaetcvjafeg stqdfad fe ocfefobc tzfbcs feocqda tla oietfeqiqssqotfiefeg im sqjgcittfo saozatfies ti ~za}aet tlafzbs~fzbtfie# bed tla da}aci~`aet im eaw aeditzbolabctqjas tlbt zasfst tla miz`btfie im b jbotazfbc jfimfc`tlbt obe ja a`jicfxad dfstbccv wftl sqotfiefeg%

    Eqtzftfie

    Tla ~zi}fsfie im bdarqbta eqtzftfie }fb tla aetazbciz ~bzaetazbc ziqtas lbs jaoi`a tla stbedbzd im obzamiz ozftfobccv fcc ~btfaets# feocqdfeg tlisa wftl BCF)BZD_# bed fs zaoi``aedad jv tla bqtlizs% Gqfda-cfeas miz eqtzftfie fe FOQ ~btfaets lb}a zaoaetcv jaaesq``bzfxad jv b oiesaesqs gziq~ im tla B`azfobeOiccaga im Olast ^lvsfofbes%22< Tla gibcs im eqtzf-tfiebc sq~~izt feocqda tla ~zi}fsfie im bdarqbtaeqtzfaets miz tla ~btfaets ca}ac im `atbjicfs`# bedtla ~za}aetfie bed tzabt aet im damfofaeofas im`bozieqtzfaets bed `fozieqtzfaets wlfca btta`~tfegti `fef`fxa oi`~cfobtfies zacbtad ti tla `ida im

    eqtzftfiebc sq~~izt% Ft fs wiztl eitfeg tlbt tla jae-amfts im eqtzftfiebc sq~~izt fe ozftfobccv fcc ~btfaetslb}a eit jaae oieocqsf}acv da`iestzbtad jv oi`-~bzfsie ti b oietzic gziq~ wlfol dfd eit zaoaf}aeqtzftfiebc sq~~izt% Tla cbok im oietziccad ocfefobctzfbcs fe tlfs bzab lbs cad bt cabst iea a|~azt226 tizaoi``aed tlbt eqtzftfiebc sq~~ca`aetbtfie jawftllacd mzi` ozftfobccv fcc ~btfaets% Ea}aztlacass# tlabqtlizs jacfa}a tlbt tla b}bfcbjca a}fdaeoa sq~~iztstla bd fefstzbtfie im eqtzftfiebc sq~~izt fe BCF)BZD_ ~btfaets%

    Tla ziqta im bd`fefstzbtfie im eqtzftfie fe BCF)BZD_ wfcc ja femcqaeoad jv tla fedf}fdqbc ~btfaet soiedftfie bed bjfcftv ti ticazbta aetazbc maadfeg%^bzaetazbc eqtzftfie lbs jaae qsad mzarqaetcv feBCF)BZD_ ~btfaets# jqt a|~azf`aetbc bed ocfefobctzfbcs sqggast tlbt aetazbc eqtzftfie `bv ja sq~azf-iz%22< Fe bef bc `idacs# cbok im aetazbc eqtzftfie~zi`itad jbotazfbc tzbesciobtfie mzi` tla gqt%2:>

    Eiz`bc lq`be }icqetaazs wli zaoaf}ad ~bzaetazbceqtzftfie lbd lfglaz ca}acs im svsta`fo bed la~btfo }afe tq`iz eaozisfs mbotiz ,TEM bztazfbc gcqobgiebed a~fea~lzfea# bed feozabsad majzfca zas~iesas tiaediti|fe oi`~bzad ti sqjhaots wli zaoaf}ad ae-tazbc eqtzftfie%2:2 Aetazbc eqtzftfie fs bcsi bssiofbtad wftl b ciwaz feofdaeoa im femaotfiqs oi`~cfobtfiestlbe ~bzaetazbc eqtzftfie#2:: bed fs cass oistcv% Tlqs#tlaza fs aeiqgl a}fdaeoa ti sq~~izt tla qsa imaetazbc maadfeg i}az ~bzaetazbc eqtzftfie wlae ~is-sfjca% Liwa}az# sfeoa aetazbc eqtzftfie fs si`atf`aseit ticazbtad fe ozftfobccv fcc ~btfaets#2:? ~bzaetazbceqtzftfie wfcc mzarqaetcv ja eaadad% Ft fs zabssqzfegti eita tlbt fe b `atb-bebcvsfs2:4 im stqdfas oi`~bz-feg titbc ~bzaetazbc eqtzftfie ti aetazbc eqtzftfiebmtaz `bhiz sqzgazv iz ozftfobc fcceass# tlaza wbs eidfmmazaeoa fe `iztbcftv jatwaae tla twi gziq~s% Febddftfie# wlae Oazzb at bc2:1 a|b`fead tla f`~bot im~bzaetazbc }s aetazbc eqtzftfie fe == ~btfaets wftlsa~sfs bt lfgl zfsk miz izgbe mbfcqza# tlav miqed eidfmmazaeoa fe tla feofdaeoa im izgbe mbfcqza iz `iz-tbcftv fe tla twi gziq~s%

    Tla oi`~isftfie im eqtzftfiebc sq~~ca`aetbtfie fe~btfaets wftl BCF)BZD_ fs be bzab im iegifegzasabzol% Iea stqdv2:= lbs za~iztad tlbt b lfgl-mbt#ciw-obzjilvdzbta dfat obe zadqoa tla dqzbtfie im }aetfcbtfie fe ~btfaets zaoaf}feg `aolbefobc }aetfcb-tfie# ~zasq`bjcv jv zadqofeg tla zas~fzbtizv rqi-tfaet bed tla ca}ac im obzjie dfi|fda ~zidqotfie%Liwa}az# tla `ist oi``ie obqsa im b lfgl zas~f-zbtizv rqitfaet fe ozftfobccv fcc ~btfaets fs sf`~cai}azmaadfeg%22< Beitlaz b~~zibol lbs jaae ti sq~-~ca`aet maadfeg wftl f``qei`idqcbtizv eqtzfaetsfeocqdfeg b fei bofds sqol bs bzgfefea bed gcq-tb`fea# zfjieqocaitfdas# bed i`agb-? mbttv bofds% B`atb-bebcvsfs2:7 im f``qei`idqcbtizv eqtzftfiebcsq~~ca`aetbtfie fe ~btfaets wftl ozftfobc fcceass

    OLA_T ) 2:> ) 4 ) IOTIJAZ# :>>2 2?1?

    Oi~vzfglt :>>2 B`azfobe Oiccaga im Olast ^lvsfofbesjv gqast ie Bqgqst :6# :>>6www%olasthiqzebc%izgDiwecibdad mzi`

    http://www.chestjournal.org/http://www.chestjournal.org/http://www.chestjournal.org/
  • 8/9/2019 Acute Respiratory Distress Syndrome 4

    9/23

    sliwad b daozabsa fe femaotfiqs oi`~cfobtfies beddqzbtfie im lis~ftbc stbv# jqt ei dfmmazaeoa fe `iztbcftv%Fe tla iecv stqdv2:< ti dbta ,bed ti iqz keiwcadga& im~btfaets wftl BCF)BZD_# b dfat lfgl fe mfsl ifc# -cfe-icaefo bofd# bed betfi|fdbets sliztaead tla dqzbtfie im`aolbefobc }aetfcbtfie bed zadqoad eaw izgbe mbfcqzasjqt lbd ei ammaot ie `iztbcftv% Qetfc cbzgaz `qctfoaetaztzfbcs im f``qei`idqcbtizv eqtzftfiebc sq~~ca`aetb-tfie fe ~btfaets wftl BCF)BZD_ bza b}bfcbjca# stbedbzdeqtzftfiebc miz`qcbtfies bza zaoi``aedad wftl b}ifd-beoa im i}azmaadfeg%

    ^itaetfbc Eaw Tzabt`aet _tzbtagfas miz

    BCF)BZD_

    _a}azbc ~zi`fsfeg eaw b~~zibolas miz f`~zi}feg~qc`iebzv gbs a|olbega bza oqzzaetcv jafeg bssassadfe ocfefobc tzfbcs bed oiqcd oietzfjqta mqztlaz tif`~zi}ad iqtoi`as fe ~btfaets wftl BCF)BZD_% Ft fsf`~iztbet ti zabcfxa# liwa}az# tlbt `iztbcftv fe ~b-tfaets wftl BCF)BZD_ fs ocisacv zacbtad ti mbotizssqol bs la~btfo mbfcqza bed sa}aza femao-tfies%2>#22#7?#2:6 Zadqotfie im `iztbcftv fe tlasa ~b-tfaets `bv zarqfza f`~zi}ad `bebga`aet im tlaoiedftfies tlbt obqsa iz oietzfjqta ti tla dvsmqeo-tfie im eie~qc`iebzv izgbe svsta`s%

    Eaw B~~zibolas ti @aolbefobc ]aetfcbtfie

    Cqeg-^zitaotf}a ]aetfcbtfie Wftl Lfglaz ^AA^8^AA^ fs tzbdftfiebccv qsad ti bolfa}a bdarqbtabztazfbc i|vgaebtfie wftliqt zasiztfeg ti ~itaetfbccvti|fo i|vgae oieoaetzbtfies%16 Liwa}az# tlaza `bvbcsi ja cqeg-~zitaotf}a ammaots im ^AA^% _a}azbcbef`bc stqdfas26#2?>#2?2 sqggast tlbt ^AA^ `bv ~za-}aet cqeg fehqzv mzi` za~abtad i~aefeg bed ocisfegim s`bcc jzieolficas bed bc}aicf# iz mzi` a|oassf}astzass bt `bzgfes jatwaae btacaotbtfo bed bazbtadcqeg qefts% Tlfs `aolbefs` im }aetfcbtiz-bssiofbtadcqeg fehqzv `bv ja `iza cfkacv fe ~btfaets wftlfedfzaot obqsas im BCF)BZD_# bs fe sa~sfs bedtzbq`b# fe wlfol aca}btfies fe bfzwbv ~zassqza tv~f-obccv obqsa sqjstbetfbc bfzs~boa zaozqft`aet%2?:#2??

    _i`a fe}astfgbtizs1< lb}a sqggastad tlbt ^AA^sliqcd ja oqsti fxad fe fedf}fdqbc ~btfaets bmtazbssass`aets im tla ~zassqza-}icq`a olbzbotazfstfosim tla zas~fzbtizv svsta` iz cqegs% _tqdfas wftla|~azf`aetbc BCF2?4 bed lq`bes wftl BCF)BZD_2?1

    da`iestzbtad zadqotfies fe femcb``btizv ovtikfeasfe tla bc}aicbz cb}bga mcqfd bed ~cbs`b wlae lfglaz^AA^ wbs qsad% Tlfs ~zitaotf}a ammaot `bv zarqfza^AA^ ca}acs tlbt bza sqjstbetfbccv lfglaz tlbe tlisatv~fobccv qsad ti sq~~izt bztazfbc i|vgaebtfie% Fe b~zis~aotf}a# zbedi`fxad tzfbc#1< ocfefobc iqtoi asf`~zi}ad fe ~btfaets wli zaoaf}ad `aolbefobc }ae-

    tfcbtfie wftl lfglaz ^AA^ ca}acs oi`~bzad ti tlisawli zaoaf}ad tzbdftfiebc ^AA^ ca}acs% Liwa}az# fetlfs stqdv#1< lfglaz ^AA^ wbs qsad fe oiehqeotfie wftl ciwaz tfdbc }icq`as bed itlaz `absqzas tizadqoa }aetfcbtiz-bssiofbtad cqeg fehqzv% Jaobqsa imtla `bev ~itaetfbc bd}azsa ammaots im ^AA^# ft fsf`~iztbet ti oiemfz` tlbt `aolbefobc }aetfcbtfie wftl lfglaz ^AA^ ca}acs# feda~aedaet im itlazcqeg-~zitaotf}a stzbtagfas# wfcc f`~zi}a f`~iztbetocfefobc iqtoi`as fe BCF)BZD_ ~btfaets% Tla EFLBZD_ Eatwizk fs oqzzaetcv oiedqotfeg b tzfbc ti tasttla }bcqa im lfglaz ca}acs im ^AA^%

    Eiefe}bsf}a ^isftf}a-^zassqza ]aetfcbtfie8 Aedi-tzbolabc fetqjbtfie fs zarqfzad miz `ist b~~cfobtfiesim ~isftf}a-~zassqza }aetfcbtfie% Oi`~cfobtfies imaeditzbolabc fetqjbtfie feocqda q~~az-bfzwbv fehq-zfas# tzbolai`bcbofb# tzbolabc staeisfs# sfeqsftfs# bed }aetfcbtiz-bssiofbtad ~eaq`iefb% Eiefe}bsf}a ~isf-tf}a-~zassqza }aetfcbtfie ,EF^^]& qsas b tfglt-mfttfegmboa `bsk bs be bctazebtf}a fetazmboa jatwaae tla~btfaet bed }aetfcbtiz ti b}ifd tlasa oi`~cfob-tfies%2?= EF^^] lbs bddftfiebc bd}betbgas im bcciw-feg si`a }azjbc oi``qefobtfie jv ~btfaets# bedsi`a ~btfaets obe abt dqzfeg slizt zas~ftas mzi` tlamboa `bsk% _tqdfas2?72?6 fe BCF)BZD_ ~btfaetsda`iestzbtad mawaz obsas im eisioi`fbc ~eaq`iefbbed sliztaz zarqfza`aets miz }aetfcbtiz bssfstbeoa fe~btfaets wli zaoaf}ad EF^^] bs oi`~bzad ti tlisa wli zaoaf}ad }aetfcbtfie }fb aeditzbolabc tqjas%Liwa}az# EF^^] fs eit mabsfjca fe dacfzfiqs izijtqedad ~btfaets%24> @izai}az# bfz cabks mzi` tlamboa `bsk `bv ~za}aet bdarqbta }aetfcbtizv bssfs-tbeoa fe ~btfaets wli zarqfza lfgl fes~fzbtizv bfzwbv~zassqzas% Bddftfiebc tf`a oi``ft`aets jv eqzsasiz zas~fzbtizv tlazb~fsts `bv ja eaadad dqzfeg tlafeftfbc ~azfid im sq~~izt wftl EF^^]%242

    Lfgl-Mzarqaeov ]aetfcbtfie8 Lfgl-mzarqaeov }ae-tfcbtfie ,LM]& qtfcfxas }azv s`bcc tfdbc }icq`as wftl}azv lfgl zas~fzbtizv zbtas%24:#24? Ft fs be bttzbotf}ab~~zibol ti `aolbefobc }aetfcbtfie fe ~btfaets wftlBCF)BZD_ jaobqsa ft bolfa}as tla twi `bfe cqeg-~zitaotf}a ijhaotf}as ,b}ifdfeg jitl i}azdfstaetfiebed }aetfcbtfie wftl btacaotbsfs bt aed-a|~fzbtfie&wlfca `bfetbfefeg eiz`bc ^boi: bs wacc bs bztazfbci|vgaebtfie%244 B tzfbc241 im LM] fe ~za`btqza fe-mbets wftl zas~fzbtizv dfstzass dfd eit da`iestzbta bsfgefmfobet ammaot ie `izjfdftv iz `iztbcftv% Liw-a}az# tla }aetfcbtfie ~zioadqzas fe tlfs stqdv241 dfdeit qsa lfgl `abe bfzwbv ~zassqzas ti bolfa}a lfglca}acs im bc}aicbz zaozqft`aet# bs fs oqzzaetcv zaoi`-`aedad%24= @iza zaoaet stqdfas247246 im LM] fe~btfaets wftl eaiebtbc zas~fzbtizv dfstzass da`ie-stzbtad zadqoad olziefo cqeg dfsabsa fe sqz}f}izs beditlaz aeoiqzbgfeg tzaeds tiwbzd f`~zi}ad iqtoi`as%

    2?14 Za}faws

    Oi~vzfglt :>>2 B`azfobe Oiccaga im Olast ^lvsfofbesjv gqast ie Bqgqst :6# :>>6www%olasthiqzebc%izgDiwecibdad mzi`

    http://www.chestjournal.org/http://www.chestjournal.org/http://www.chestjournal.org/
  • 8/9/2019 Acute Respiratory Distress Syndrome 4

    10/23

    Tla zasqcts im b cbzga zbedi`fxad# oietziccad tzfbc21> imLM] fe bdqcts wftl boqta zas~fzbtizv mbfcqza wazadfsb~~ifetfeg# jqt tlfs stqdv feocqdad b latazigaeaiqsgziq~ im ~btfaets% @izai}az# tla LM] ~zioadqzas fetlfs tzfbc21>waza eit dasfgead ti b}ifd }aetfcbtfie wftlbtacaotbsfs bt aed-a|~fzbtfie% Qeoietziccad stqdfas212#21:

    za~iztad tlbt gbs a|olbega oiqcd ja `bfetbfead btbooa~tbjca ca}acs wftl LM] fe ~btfaets wftl sa}azaBZD_% Zbedi`fxad tzfbcs wfcc ja eaoassbzv ti dataz-`fea fm f`~iztbet ocfefobc iqtoi`as f`~zi}a wftl LM]wlae oi`~bzad ti oie}aetfiebc }aetfcbtiz-jbsad cqeg-~zitaotf}a stzbtagfas%

    Tzbolabc Gbs Fesqmmcbtfie8 ^lvsficigfo dabd s~boafs aca}btad fe ~btfaets wftl BCF)BZD_# bed s`bcctfdbc }icq`a }aetfcbtfie mzarqaetcv obqsas lv~azob~-efb bed boqta bofdisfs% Tzbolabc gbs fesqmmcbtfie,TGF& fs be bdhqeot ti `aolbefobc }aetfcbtfie tlbtzadqoas dabd s~boa%21?217 Ft fs tlazamiza bttzbotf}amiz qsa wftl s`bcc tfdbc }icq`a }aetfcbtfie fe BCF)BZD_ ~btfaets ti bttaeqbta tla zasqctfeg lv~azob~-efb bed bofdisfs%

    Wftliqt TGF# tla jzieolf bed tzbolab bza mfccad wftl bc}aicbz gbs bt tla aed im a|lbcbtfie% Tlfsobzjie dfi|fda-cbdae gbs fs mizoad jbok feti tlabc}aicf dqzfeg tla ea|t fes~fzbtfie% Wftl TGF# bstzab` im mzasl gbs ,b~~zi|f`btacv 4 ti < C)`fe& fsfesqmmcbtad tlziqgl b s`bcc obtlataz iz tlziqgl s`bccolbeeacs fe tla wbcc im tla aeditzbolabc tqja feti tlaciwaz tzbolab# mcqslfeg tla obzjie dfi|fda-cbdae gbsiqt ~zfiz ti tla ea|t fes~fzbtfie% TGF `bv obqsadasfoobtfie im saozatfies bed bfzwbv `qoisbc fehqzv#bed tla TGF obtlataz `bv jaoi`a b efdqs mizbooq`qcbtfie im saozatfies% TGF `bv bcsi obqsabqti-^AA^ mzi` tla a|~fzbtizv mciw bed zasfstbeoaim tla }aetfcbtiz-a|lbcbtfie tqjas bed }bc}a% Tlada}aci~`aet im s~aofbc arqf~`aet bed a|~cfoftgqfdacfeas `bv bcciw ocfefofbes ti qsa TGF fe tlaeabz mqtqza ti `bebga ~btfaets wftl sa}aza lv~az-ob~efb bed bofdisfs%

    ^zi~iztfiebc-Bssfst ]aetfcbtfie8 Cfka itlaz `idasim ~isftf}a-~zassqza }aetfcbtfie# ~zi~iztfiebc-bssfst}aetfcbtfie aca}btas bfzwbv ~zassqza dqzfeg fes~fzb-tfie% Qecfka itlaz `idas# tla fes~fzbtizv bfzwbv~zassqza bssfstbeoa }bzfas dfzaotcv wftl ~btfaet am-mizt%21< Tlfs bcciws jzabtl-ti-jzabtl }bzfbtfies fefes~fzbtizv bfzmciw bed tfdbc }icq`a# bs wftl ~zas-sqza-sq~~izt }aetfcbtfie# jqt tla `bgeftqda im tla~zassqza bssfstbeoa feozabsas wftl ~btfaet ammizt%@izai}az# tla fes~fzbtizv bssfstbeoa obe ja oqsti`-fxad ti tla acbstbeoa bed zasfstbeoa ~zi~aztfas imabol ~btfaets zas~fzbtizv svsta`% ^zi~iztfiebc-bssfst}aetfcbtfie obe bcsi ja bdhqstad ti ~zi}fda `iza izcass ~isftf}a-~zassqza bssfstbeoa# da~aedfeg ie b~btfaets bjfcftv ti sqstbfe si`a }aetfcbtfie% Tlfs

    `ida fs `ist mb}izbjca miz jzabtlfeg oi`mizt bed mizzadqofeg qeeaoassbzv wizk im jzabtlfeg% Ft `bv jatla jast `ida ti qsa wftl EF^^]%216

    Fe}azsa-Zbtfi ]aetfcbtfie bed Bfzwbv ^zassqza-Zacabsa ]aetfcbtfie8 _i`a fe}astfgbtizs2=>#2=2 lb}asqggastad tlbt btacaotbtfo bc}aicf `bv ja zaozqftadbed stbjfcfxad jv a|taedfeg tla dqzbtfie im fes~fzb-tfie bed sliztaefeg tla dqzbtfie im a|~fzbtfie% Fm si#tlae slqet oiqcd ja zadqoad bed bztazfbc i|vgae-btfie f`~zi}ad wftliqt feozabsfeg ^AA^# fes~fzbtizvbfzwbv ~zassqzas# tfdbc }icq`a# iz cqeg stzatol%

    Fe}azsa-zbtfi }aetfcbtfie ,FZ]& fs bssiofbtad wftlslqet zadqotfie bed f`~zi}ad bztazfbc i|vgaebtfie fe~btfaets wftl BCF)BZD_%2=22=? Liwa}az# tla slizta|lbcbtfie tf`as im FZ] ~zijbjcv obqsa si`a bqti-^AA^%2=4#2=1 Tlqs# f`~zi}ad gbs a|olbega fe ~za}f-iqs stqdfas wftl FZ] `bv lb}a iooqzzad jaobqsa imbe feozabsa fe aed-a|~fzbtizv bc}aicbz ~zassqza% Fetlzaa stqdfas=2#=:#2== fe BZD_ ~btfaets# ammaots im FZ]ie slqet bed i|vgaebtfie waza oi`~bzad wftl am-maots im ^AA^ wftliqt FZ]% Wlae aed-a|~fzbtizvbc}aicbz ~zassqzas iz tlizbofo }icq`as waza `btoladdqzfeg FZ] bed oie}aetfiebc }aetfcbtfie# bztazfbci|vgaebtfie bed slqet waza sf`fcbz% Tlasa stqdfassqggast tlbt tla `aolbefs` jv wlfol FZ] f`~zi}asi|vgaebtfie fs tla sb`a bs wftl a|tazebccv b~~cfad^AA^8 tlbt slqet zadqotfie dias eit iooqz wftl FZ]qecass tlaza fs feozabsad aed-a|~fzbtizv bc}aicbz~zassqza%2=7 Jaobqsa FZ] fs }azv qeoi`miztbjca#`ist ~btfaets wfcc zarqfza lab}v sadbtfie# bed `bevwfcc zarqfza eaqzi`qsoqcbz jciokbda% Tlaza fs gziw-feg bwbzaeass im oi`~cfobtfies mzi` sadbtfie bed~bzbcvsfs fe ozftfobccv fcc ~btfaets%6?#2= ) 4 ) IOTIJAZ# :>>2 2?11

    Oi~vzfglt :>>2 B`azfobe Oiccaga im Olast ^lvsfofbesjv gqast ie Bqgqst :6# :>>6www%olasthiqzebc%izgDiwecibdad mzi`

    http://www.chestjournal.org/http://www.chestjournal.org/http://www.chestjournal.org/
  • 8/9/2019 Acute Respiratory Distress Syndrome 4

    11/23

    _qzmbotbet Za~cboa`aet Tlazb~v

    _qzmbotbet# wlfol fs eiz`bccv ~zidqoad jv tv~a FF~eaq`iovtas# daozabsas sqzmboa taesfie bt tla bfz-mcqfd fetazmboa im s`bcc bfzwbvs bed bc}aicf% Wftliqttla jaeamfofbc ammaot im sqzmbotbet# bc}aicf `bv oic-cb~sa bed zasfst i~aefeg# a}ae wftl lfgl bfzwbv~zassqzas% Fe zas~fzbtizv dfstzass svedzi`a im ~za-

    `btqza fembets# sqzmbotbet ~zidqotfie jv tla f``b-tqza cqeg fs damfofaet bed sqzmbotbet za~cboa`aettlazb~v fs jaeamfofbc%27? Fe BCF)BZD_# fehqzad tv~aFF ~eaq`iovtas ~zidqoa cass sqzmbotbet# bed ~cbs`b~zitafes tlbt cabk feti tla bc}aicbz bfzs~boas febotf-}bta a|fstfeg sqzmbotbet% @izai}az# b olbega fe tlacf~fd oi`~isftfie im sqzmbotbet oietzfjqtas ti ~iizsqzmbotbet mqeotfie%274 Tla zasqctfeg feozabsa fe sqz-mboa taesfie cabds ti btacaotbsfs bed daozabsad cqegoi`~cfbeoa274 bed `bv bcsi feozabsa ada`b miz`b-tfie%271 _a}azbc a|~azf`aetbc stqdfas fe BCF `idacsda`iestzbtad f`~zi}ad ~qc`iebzv mqeotfie# feocqd-

    feg cqeg oi`~cfbeoa bed i|vgaebtfie# wlae a|iga-eiqs sqzmbotbet wbs bd`fefstazad%274

    Feftfbc ocfefobc stqdfas27= im a|igaeiqs sqzmbotbettlazb~v fe ~btfaets wftl BZD_ waza aeoiqzbgfeg%Liwa}az# fe b `qctfoaetaz# zbedi`fxad# ~cboaji-oietziccad tzfbc277 fe 7:1 ~btfaets wftl sa~sfs-fedqoadBZD_# be bztfmfofbc ~zitafe-mzaa sqzmbotbet gf}ae jvbazisic dfd eit bmmaot bztazfbc i|vgaebtfie# dqzbtfieim `aolbefobc }aetfcbtfie# iz sqz}f}bc% Tlaza bzasa}azbc ~issfjca a|~cbebtfies miz tlasa zasqcts% Mfzst#sqzmbotbet dacf}azv ti tla bc}aicf `bv lb}a jaaefebdarqbta% Ft fs astf btad tlbt iecv 1! im tla

    bazisicfxad disa bd`fefstazad fe tlfs tzfbc zaboladtla dfstbc bfzs~boas%27< _aoied# bztfmfofbc ~zitafe-mzaasqzmbotbets `bv eit ja bs ammaotf}a bs ebtqzbc sqzmbo-tbets iz ~zitafe-oietbfefeg bztfmfofbc sqzmbotbet%274

    Tlfzd# tla femcb``btizv fehqzv fe ~btfaets wftlBZD_ imtae ~zigzassas ti mfjzitfo dastzqotfie im tlacqeg% Tlfs `bv eit ja b`acfizbtad jv sqzmbotbetza~cboa`aet% Miqztl# `ist ~btfaets wftl BCF)BZD_di eit dfa mzi` zas~fzbtizv mbfcqza jqt festabd mzi`dvsmqeotfie iz mbfcqza im `qctf~ca eie~qc iebzvizgbe svsta`s%2>#22#74 _qzmbotbet tlazb~v# a}ae fm i~-tf`bccv ammaotf}a fe zadqofeg sqzmboa taesfie# bc}aicbz

    oiccb~sa# bed slqet# wiqcd eit lb}a b dfzaot ammaot ieqeoietziccad femaotfies bed eie~qc iebzv izgbedvsmqeotfie% _i`a eawaz sqzmbotbet ~za~bzbtfieswftl zaoi`jfebet sqzmbotbet ~zitafes bza fe oqzzaetocfefobc tzfbcs fe BCF)BZD_ ~btfaets% Fe tlasa stqdfas#tla sqzmbotbet ~za~bzbtfies bza jafeg dacf}azad fetitla cqeg tlziqgl tla aeditzbolabc tqja iz jv jzie-olisoi~fo festfccbtfie%

    A|tzboiz~izabc Gbs A|olbega

    Das~fta `b|f`bc sq~~iztf}a obza wftl `aolbefobc }aetfcbtfie# si`a ~btfaets wftl BCF)BZD_ a|~azf-

    aeoa zamzbotizv lv~i|a`fb# cabdfeg si`a fe}astfgb-tizs ti sqggast tlbt a|tzboiz~izabc `a`jzbea i|v-gaebtfie ,AO@I& wiqcd ja qsamqc fe tlasa~btfaets%276 B ~zis~aotf}a# `qctfoaetaz# zbedi`fxadtzfbc2 wbs oiedqotad ti oi`~bza AO@I ti oie-}aetfiebc }aetfcbtfie bciea; `iztbcftv fe jitl gziq~sim ~btfaets wbs b~~zi|f`btacv 6>!%

    _feoa tla feftfbc a|~azfaeoa wftl AO@I# a|tzboiz-~izabc gbs a|olbega taoleicigv lbs jaae f`~zi}adti daozabsa oi`~cfobtfies bed f`~zi}a iqtoi`as% Fetla abzcv AO@I tzfbc# i|vgaebtfie wbs tla ~zf`bzvijhaotf}a% Ti bolfa}a ammaotf}a bztazfbc i|vgaebtfie#jciid mciw tlziqgl tla a|tzboiz~izabc da}foa lbd tija 1>! im obzdfbo iqt~qt% A|tzboiz~izabc obzjiedfi|fda za`i}bc ,AOoi:Z& lbs eiw jaae da}aci~ad wftl tla ~zf bzv ijhaotf}a im zadqofeg tla lfglzas~fzbtizv zbtas bed tfdbc }icq`as zarqfzad tibolfa}a eiz`bc ^boi:# tlazajv daozabsfeg }aetfcb-tiz-bssiofbtad cqeg fehqzv% Tlfs gibc obe ja bolfa}ad wftl ciwaz a|tzboiz~izabc jciid mciw zbtas# jqtbolfa}as iecv :> ti ?>! im titbc i|vgae zarqfza-`aets%2

  • 8/9/2019 Acute Respiratory Distress Syndrome 4

    12/23

    ~ziea ~isftfiefeg% Liwa}az# tla f`~zi}a`aets fesi`a ~btfaets bza rqfta stzfkfeg# bcciwfeg sqjstbetfbczadqotfie fe Mfi: bed ^AA^%

    Tla `aolbefs` jv wlfol tla ~ziea ~isftfief`~zi}as i|vgaebtfie lbs jaae fe}astfgbtad a|~azf-`aetbccv% Fe b ~fg `idac im BCF# Cb`` at bc26>

    da`iestzbtad f`~zi}ad }aetfcbtfie ti ~za}fiqscv da-~aedaet ,dizsbc& zagfies fe tla ~ziea ~isftfie% Fe tlasq~fea ~isftfie# ~caqzbc ~zassqzas waza lfglaz eabztla `iza da~aedaet dizsbc zagfies dqa ti lvdzi-stbtfo gzbdfaets% Lfglaz ~caqzbc ~zassqzas zadqoadtzbes`qzbc ~zassqzas im da~aedaet jzieolficas bedbc}aicf# oietzfjqtfeg ti tla taedaeov miz btacaotbsfs fetlasa cqeg xieas% Fe tla ~ziea ~isftfie# ~caqzbc~zassqzas b~~abzad `iza qefmiz`# bcciwfeg si`adizsbc zagfies ti i~ae bed ~bztfof~bta fe }aetfcbtfiebed gbs a|olbega% Tlfs sqggasts tlbt ~ziea ~isftfie-feg oiqcd ~za}aet }aetfcbtiz-bssiofbtad cqeg fehqzv jv~zi`itfeg `iza qefmiz` dfstzfjqtfie im tfdbc }icq`abed jv zaozqftfeg dizsbc cqeg zagfies# ~za}aetfegza~abtad i~aefeg bed ocisfeg im s`bcc bfzwbvs iza|oassf}a stzass bt `bzgfes jatwaae bazbtad bedbtacaotbtfo dizsbc cqeg qefts%

    ^acisf at bc2 l)d#bcciwfeg zacbtf}acv jzfam ~azfids im sq~fea ~isftfiefegmiz jbtlfeg# saz}fofeg im }bsoqcbz obtlatazs# bed mizzacfam im ~zassqza ie }aetzbc sqzmboas% Tlfs soladqca`bv ja `bfetbfead qetfc zarqfza`aets miz }aetfcbtizbssfstbeoa df`fefsl bed wabefeg b~~abzs mabsfjca%

    Mcqiziobzjie Cfrqfd-Bssfstad Gbs A|olbega

    Bs ~za}fiqscv dfsoqssad# zadqoad sqzmbotbet mqeo-tfie bed feozabsad sqzmboa taesfie obqsa oiccb~sa ims`bcc bfzwbvs bed bc}aicf fe BZD_ ~btfaets% _qzmboataesfie obe ja acf`febtad jv mfccfeg tla cqegs wftl bcfrqfd sqol bs sbcfea sicqtfie% Liwa}az# jaobqsa imtla ciw obzzvfeg ob~boftv im sbcfea sicqtfie miz i|vgaebed obzjie dfi|fda# ft fs f`~issfjca ti `bfetbfebdarqbta gbs a|olbega wftl sbcfea sicqtfie }aetfcb-tfie% Izgbefo mcqiziobzjie cfrqfds obe dfssic}a 27tf`as `iza i|vgae tlbe wbtaz#26: lb}a ciw sqzmboataesfie# bed s~zabd rqfokcv i}az tla zas~fzbtizva~ftlacfq`% Tlav b~~abz ti ja eieti|fo# bza `fef-`bccv bjsizjad# bed bza acf`febtad jv a}b~izbtfietlziqgl tla cqegs% Zadqoad sqzmboa taesfie `bvf`~zi}a bc}aicbz zaozqft`aet# bztazfbc i|vgaebtfie#bed feozabsa cqeg oi`~cfbeoa# a}ae wftl s`bccb`iqets im tla sqjstbeoa festfccad feti tla cqeg# bswftl sqzmbotbet tlazb~v%

    Mcqiziobzjies lb}a jaae qsad fe bef`bcs wftltitbc cfrqfd }aetfcbtfie%26? Tlfs b~~zibol zarqfzas bcfrqfd }aetfcbtiz-gbs a|olbega da}foa ti i|vgaebtatla cfrqfd# dacf}az tla tfdbc }icq`a# bed za`i}aobzjie dfi|fda% Be bctazebtf}a b~~zibol fs ~bztfbccfrqfd }aetfcbtfie# fe wlfol tla cqegs bza mfccadb~~zi|f`btacv ti mqeotfiebc zasfdqbc ob~boftv% Gbs }aetfcbtfie fs tlae oietfeqad wftl b oie}aetfiebc}aetfcbtiz%26426< Fe tlasa }bzfiqs bef`bc `idacs imcqeg fehqzv# titbc bed ~bztfbc cfrqfd }aetfcbtfie f`-~zi}ad gbs a|olbega wlae oi`~bzad ti oie}ae-tfiebc }aetfcbtfie% Tla f`~zi}a`aet fe gbs a|olbegafs ~zijbjcv a|~cbfead jv bc}aicbz zaozqft`aet% _tqd-fas266#:>> fe lq`bes wftl BZD_ bcsi sliwad ~zi`-fsfeg f`~zi}a`aets fe gbs a|olbega% Btacaotbsfs bedbc}aicbz mfccfeg bza mzarqaetcv wizsa fe da~aedaetcqeg zagfies#24 bed tla daesa mcqiziobzjie taeds tigzb}ftbta ti tlasa zagfies# wlaza ft fs im ~itaetfbccvgzabtast }bcqa miz bc}aicbz zaozqft`aet% @izai}az#tla wafglt bed zasqctfeg ~zassqza im tla cfrqfd feda~aedaet zagfies `bv df}azt jciid mciw ti eieda-~aedaet# jattaz-}aetfcbtad zagfies%

    OLA_T ) 2:> ) 4 ) IOTIJAZ# :>>2 2?17

    Oi~vzfglt :>>2 B`azfobe Oiccaga im Olast ^lvsfofbesjv gqast ie Bqgqst :6# :>>6www%olasthiqzebc%izgDiwecibdad mzi`

    http://www.chestjournal.org/http://www.chestjournal.org/http://www.chestjournal.org/
  • 8/9/2019 Acute Respiratory Distress Syndrome 4

    13/23

    Tla qsa im `aolbefobc }aetfcbtfie wftl lfgl bfzwbv~zassqzas `bv stfcc ja fehqzfiqs ti tla cqeg ~bzae-olv`b dqzfeg cfrqfd }aetfcbtfie# bs dqzfeg gbs }aetf-cbtfie% Fe titbc cfrqfd }aetfcbtfie# tlaza fs bcsi tla zfskim `aolbefobc fetazmazaeoa wftl }aeiqs zatqze%Tlaza wbs `fef bc la`idveb fo festbjfcftv wftl~bztfbc cfrqfd }aetfcbtfie bt b disa im :> `C)kg%264

    Festfccbtfie im gzabtaz }icq`as im mcqiziobzjie `bvdaozabsa obzdfbo iqt~qt jv b sf`fcbz `aolbefs` bslfgl ^AA^%26< Tlaza bza si`a aeoiqzbgfeg za~iztsim tla sbmatv bed ammfobov im ~bztfbc cfrqfd }aetfcbtfiefe bdqcts266 bed ~adfbtzfo ~btfaets:>> wftl BZD_# bswacc bs fe eaiebtas wftl zas~fzbtizv dfstzass%:>2 Liw-a}az# `iza fe}astfgbtfie fs eaadad ti da`iestzbtaf`~zi}a`aets fe kav ocfefobc iqtoi`as jamiza tlfsei}ac taolefrqa obe ja bdi~tad miz ziqtfea ocfefobcqsa fe BCF)BZD_ ~btfaets%

    Betf-femcb``btizv _tzbtagfas

    Tla femcb``btizv zas~iesa fe BCF fs bssiofbtad wftl zaozqft`aet im cbzga eq`jazs im eaqtzi~lfcsbed `ieiovtas ti tla dfstbc bfzs~boas im tla cqeg bedtla zacabsa im ~zifemcb``btizv `icaoqcas# feocqdfegovtikfeas# i|vgae zbdfobcs# bed ~zitabsas%:>: A|oas-sf}a femcb``btfie `bv wizsae BCF)BZD_% Bs dfs-oqssad jaciw# si`a zaoaet stqdfas sqggastad tlbtf`~iztbet ocfefobc iqtoi`as fe BCF)BZD_ ~btfaetswiqcd f`~zi}a wftl `idqcbtfie im cqeg femcb``b-tfie% Itlaz stqdfas waza dfsb~~ifetfeg%

    Tlazb~aqtfo _tzbtagfas ti Zadqoa _a~sfs-Fedqoad

    BZD_8 ^btfaets wftl BCF)BZD_ mzi` sa~sfs lb}alfglaz `iztbcftv tlbe ~btfaets wftl BCF)BZD_ mzi``ist itlaz obqsas%2>#7? Tzabt`aet im sa~sfs jamiza izfe tla abzcv ~lbsa im BCF)BZD_ oiqcd f`~zi}aiqtoi`as fe tlasa ~btfaets% Qemiztqebtacv# tla za-sqcts im tzfbcs im lfgl disas im gcqoioiztfoifds#:>?:>1

    betfaediti|fe `ieiociebc betfjidv# betfTEM-tlazb~v# bed betffetazcaqkfe ,FC&-2 tlazb~v wazadfsb~~ifetfeg% Liwa}az# zaoaetcv# botf}btad ~zitafeO lbs jaae sliwe ti zadqoa `iztbcftv fe sa~sfs~btfaets:>= jv ei}ac betf-femcb``btizv bed betfoi-bgqcaet `aolbefs`s%:>7

    Gcqoioiztfoifd Tlazb~v8 Bs dfsoqssad fe tla ~za-oadfeg saotfie# lfgl disas im gcqoioiztfoifds di eit~za}aet tla da}aci~`aet im BZD_ fe ~btfaets wftlsa~sfs% Fe bddftfie# zbedi`fxad# oietziccad ocfefobctzfbcs:>?:>1 dfd eit sliw jaeamfofbc ammaots wlae lfgldisas im gcqoioiztfoifds waza bd`fefstazad ti BCF)BZD_ ~btfaets abzcv fe tlafz oiqzsa% Fetazastfegcv# feiea im tlasa stqdfas#:>4 sazq` oi`~ca`aet ca}acs waza eit ciwazad fe ~btfaets wftl sa~sfs-fedqoadBZD_ wli waza tzabtad wftl lfgl-disa `atlvc~zad-efsiciea% _feoa si`a ~btfaets wftl cbta-~lbsa BCF)

    BZD_ lb}a ~azsfstaet femcb``btfie# mfjzi~zicfmazb-tfie# bed femcb``btizv ovtikfea zacabsa fe tlabfzs~boas im tla cqeg# gcqoioiztfoifds bt tlfs cbtastbga oiqcd `idqcbta tlasa ~zioassas bed mbofcftbtazaoi}azv% Liwa}az# gcqoioiztfoifds oiqcd bcsi fe-ozabsa zfsks im eisioi`fbc femaotfies# wlfol wiqcddf`fefsl olbeoas miz zaoi}azv% _a}azbc obsa sazfasza~izts:>6 sqggastad tlbt gcqoioiztfoifds oiqcdciwaz `iztbcftv fe si`a ~btfaets wftl sa}aza BCF)BZD_ wlae bd`fefstazad sa}azbc dbvs bmtaz BCF)BZD_ iesat% Fe b s`bcc# zbedi`fxad# ~cboaji-oie-tziccad tzfbc#:2> f`~iztbet ocfefobc iqtoi as wazajattaz fe ~btfaets zbedi`fxad ti zaoaf}a `atlvc~zad-efsiciea fe tla cbta ~lbsa im BCF)BZD_% Tlfs wbs bs`bcc tzfbc ,2= ~btfaets zbedi`fxad ti zaoaf}a `atl- vc~zadefsiciea bed < ~btfaets ti zaoaf}a ~cboajibed sa}azbc ~btfaets ozissad i}az jatwaae stqdvgziq~s% Tla EFL BZD_ Eatwizk fs oiedqotfeg bcbzgaz ~zis~aotf}a# zbedi`fxad# diqjca-jcfed tzfbc tioiemfz` tlasa zasqcts%

    Betfi|fdbet Tlazb~v8 Tlaza fs oie}feofeg a}f-daeoa tlbt zabotf}a i|vgae s~aofas ~cbv b `bhiz zicafe `adfbtfeg fehqzv ti tla aeditlacfbc jbzzfaz im tlacqeg fe tla ~zasaeoa im aediti|fe# jbotazfbc sa~sfs# izlv~azi|fo cqeg fehqzv% Betfi|fdbet tlazb~v lbs jaaeqsamqc fe tla ~za}aetfie bed tla tzabt`aet im BCF fesi`a bef`bc `idacs%:22 ^btfaets wftl BCF)BZD_a|~azfaeoa i|fdbtf}a stzass mzi` eaqtzi~lfc botf}b-tfie bed mzi` lfgl ca}acs im fes~fzad i|vgae%:2:Wizkjv Rqfecbe at bc:2? fedfobtas tlbt ~btfaets wli di eitsqz}f}a BZD_ sqstbfe `qol gzabtaz ca}acs im i|fdb-tf}a `icaoqcbz db`bga# sqggastfeg tlbt tlafz betfi|-fdbet damaesa `aolbefs`s bza wabkaead%

    E-boatvcovstafea bed ~ziovstafea# i|vgae mzaa-zbdfobc sob}aegazs bed ~zaoqzsizs miz gcqtbtlfiea#waza ammfobofiqs fe si`a a|~azf`aetbc stqdfas%:22 Fe~lbsa FF ocfefobc stqdfas:24#:21 fe BCF)BZD_ bedsa~sfs# tlaza waza aeoiqzbgfeg tzaeds fe f`~iztbetocfefobc iqtoi`as fe ~btfaets wli zaoaf}ad tlasabgaets% Liwa}az# tla zasqcts im b cbzga# zbedi`fxad#~cboaji-oietziccad tzfbc mbfcad ti sliw jaeamfofbcammaots im ~ziovstafea fe ~btfaets wftl BCF)BZD_%:

    ^zistbgcbedfe Bgiefsts)Felfjftizs8 ^zistbgcbedfeA2 fs b }bsidfcbtiz tlbt jcioks ~cbtacat bggzagbtfiebed daozabsas eaqtzi~lfc botf}btfie% Tlfs bgaetsliwad ~zi fsa fe a|~azf`aetbc bed ~zacf febzvocfefobc stqdfas im cqeg fehqzv%6< Liwa}az# b `qctf-oaetaz stqdv66 im 2>> BCF)BZD_ ~btfaets za~iztadei a}fdaeoa im zadqoad `iztbcftv fe tlisa tzabtad wftl F] ~zistbgcbedfe A2% Cf~isi`bc dacf}azv im~zistbgcbedfe A2 wbs bcsi eit jaeamfofbc fe b ~lbsa FFstqdv%:2=

    Tla svetlasfs im ovocii|vgaebsa ~zidqots im tla~zistbgcbedfe ~btlwbv# ~bztfoqcbzcv tlzi`ji|bea#

    2?1< Za}faws

    Oi~vzfglt :>>2 B`azfobe Oiccaga im Olast ^lvsfofbesjv gqast ie Bqgqst :6# :>>6www%olasthiqzebc%izgDiwecibdad mzi`

    http://www.chestjournal.org/http://www.chestjournal.org/http://www.chestjournal.org/
  • 8/9/2019 Acute Respiratory Distress Syndrome 4

    14/23

    lbs jaae cfekad wftl bjeiz`bc bfzwbv `aolbefos#lv~i|a`fb# svsta`fo lv~itaesfie# bed `qctf~ca iz-gbe dvsmqeotfie fe bef bc `idacs im cqeg fehqzv%Tlazamiza# b ~zis~aotf}a# diqjca-jcfed# zbedi`fxadtzfbc:>7 tastad tla bjfcftv im fjq~zimae# be felfjftiz imtla ovocii|vgaebsa ~btlwbv# ti zadqoa `izjfdftvbed `iztbcftv fe 411 ~btfaets wftl sa~sfs wli waza btzfsk im `qctf~ca izgbe mbfcqza# feocqdfeg BZD_%Das~fta be !& bed tlafjq~zimae gziq~ ,?7!& waza sf`fcbz# bed tlaza wazaei sfgefmfobet ammaots ie tla dqzbtfie im sliok iz feizgbe mbfcqza-mzaa dbvs%:>7

    Katioiebxica# b ~itaet felfjftiz im tlzi`ji|beabed caqkitzfaea svetlasfs#:27wbs za~iztad ti ~za}aettla da}aci~`aet im BCF)BZD_ fe lfgl-zfsk sqzgfobc~btfaets%:2< Liwa}az# wlae tlfs bgaet wbs stqdfad febe EFL-s~iesizad `qctfoaetaz ~lbsa FFF tzfbc:26 titast fts ammfobov miz daozabsfeg `iztbcftv bed tladqzbtfie im bssfstad }aetfcbtfie fe :?4 ~btfaets wftlBCF)BZD_# tlaza wbs ei daozabsa fe `iztbcftv mizkatioiebxica tzabt`aet ,?1!& }s tla ~cboaji gziq~,?4! bed tla `adfbe eq`jaz im }aetfcbtiz-mzaadbvs wbs 6 fe tla ~cboaji gziq~ }s 2> dbvs fe tlakatioiebxica gziq~%

    Cfsimvccfea bed ^aeti|fmvccfea8 ^aeti|fmvccfea fs b~lis~lidfastazbsa felfjftiz tlbt felfjfts eaqtzi~lfcola`itb|fs bed botf}btfie fe bef`bc `idacs imBZD_%::>::: Cf`ftad ocfefobc a|~azfaeoa fe lq`bessqggasts si`a jaeamfofbc ammaots#::? jqt tlaza fs eitaeiqgl femiz`btfie ti bcciw damfefta zaoi``aedb-tfies miz ocfefobc qsa% Cfsimvccfea fs ola`fobccv zacbtadti ~aeti|fmvccfea# jqt fts betf-femcb``btizv `aolb-efs` fs tlziqgl felfjftfie im tla zacabsa im mzaa-mbttvbofds mzi` oacc `a`jzbeas qedaz i|fdbtf}astzass%::4#::1 Fe bef`bc stqdfas#::= cfsimvccfea felfjftadzacabsa im TEM# FC-2# bed FC-=# bttaeqbtad sliok-fedqoad cqeg fehqzv fe `foa# bed lbd mb}izbjcaammaots ie tla oiqzsa im `qzfea aediti|fe sliok%Qemiztqebtacv# b zaoaetcv oi`~catad ~lbsa FFF tzf-bc::7 jv tla EFL BZD_ Eatwizk fe ::> BCF)BZD_~btfaets sliwad ei jaeamfofbc ammaots im cfsimvccfea%

    BetfFC-< Tlazb~v bed Itlaz ^itaetfbc Betf-fe- mcb` btizv _tzbtagfas8 Itlaz betf-femcb``btizvstzbtagfas oiqcd ja ammaotf}a fe bttaeqbtfeg cqegfehqzv iz ~za}aetfeg fts da}aci~`aet fe lfgl-zfsk~btfaets% Iea b~~zibol fs ti zadqoa tla eq`jaz imeaqtzi~lfcs tlbt `fgzbta feti tla a|tzb}bsoqcbz s~boaim tla cqeg jv fetazmazfeg wftl eaqtzi~lfc bdlasfie titla cqeg aeditlacfq`# iz jv zadqofeg tla zacabsa imola`itbotfo mbotizs fe tla a|tzb}bsoqcbz s~boa% Tlazafs stzieg a|~azf`aetbc a}fdaeoa miz felfjftfeg tlazacabsa im FC--= `ic)C% Tlfs fs tla sb`a oieoae-tzbtfie tlbt wbs bolfa}ad fe tla bc}aicbz oi`~bzt-`aet fe slaa~ stqdfas fe wlfol sbc`atazic wbsbazisicfxad fe b ocfefobccv zaca}bet disbga im 1 `g)l%:?< Tlasa stqdfas sqggast tlbt :-bgiefsts obe jadacf}azad jv bazisic fe fetqjbtad ~btfaets zaoaf}feg`aolbefobc }aetfcbtfie bed obe bolfa}a oieoaetzb-tfies fe tla dfstbc bfzs~boas im tla cqeg tlbt wfccaelbeoa bc}aicbz mcqfd ocabzbeoa%

    Obe sidfq` bed mcqfd tzbes~izt ja stf`qcbtad wftl:-bgiefsts fe tla ~zasaeoa im cqeg fehqzv9 Fe tlzaa

    OLA_T ) 2:> ) 4 ) IOTIJAZ# :>>2 2?16

    Oi~vzfglt :>>2 B`azfobe Oiccaga im Olast ^lvsfofbesjv gqast ie Bqgqst :6# :>>6www%olasthiqzebc%izgDiwecibdad mzi`

    http://www.chestjournal.org/http://www.chestjournal.org/http://www.chestjournal.org/
  • 8/9/2019 Acute Respiratory Distress Syndrome 4

    15/23

    zaoaet stqdfas:?6:42 fe lv~azi|fo cqeg fehqzv `idacsfe zbts# fetzb-bc}aicbz tazjqtbcfea bd fefstzbtfie`bzkadcv feozabsad bc}aicbz mcqfd ocabzbeoa% Fe tlasastqdfas# tla ada`b wbs ~zijbjcv oiemfead ~zadi`f-ebetcv ti tla fetazstftfq % Liwa}az# tla zasqctsastbjcfslad tlbt a|igaeiqs :-bgiefst tlazb~v oiqcdfeozabsa bc}aicbz bed cqeg mcqfd ocabzbeoa fe tlafehqzad cqeg% Fe itlaz stqdfas#:?= bc}aicbz mcqfd ocabz-beoa wbs `bzkadcv feozabsad jv aedigaeiqs a~f-ea~lzfea zacabsa fe tla ~zasaeoa im aediti|a`fb izjbotaza`fb% Liwa}az# micciwfeg ~ziciegad la`iz-zlbgfo sliok fe zbts# i|fdbet `aolbefs`s daozabsadtla zas~iesa im tla bc}aicbz a~ftlacfq` ti :-bgiefststf`qcbtfie%:4: Tlqs# qedaz si`a ofzoq`stbeoas# tlaa~ftlacfq` `bv eit zas~ied ti :-bgiefst stf`qcb-tfie jaobqsa im a|taesf}a fehqzv bed ciss im bc}aicbztv~a FF oaccs iz jaobqsa im diwezagqcbtfie im tlazas~iesa ti :-bgiefsts% Oietziccad ocfefobc tzfbcs bzaeaadad ti a}bcqbta bazisicfxad -bdzaeazgfo bgiefsttlazb~v fe ~btfaets wftl BCF)BZD_%

    Fe bddftfie ti bazisicfxad :-bgiefsts# bc}aicbza~ftlacfbc mcqfd ocabzbeoa oiqcd ja feozabsad wftlsvsta`fobccv dacf}azad :-bgiefsts% Dijqtb`fea# boi``iecv qsad :-bdzaeazgfo bgiefst# `bzkadcv fe-ozabsad bc}aicbz bed cqeg mcqfd ocabzbeoa fe bea|~azf`aetbc zbt `idac im ~qc`iebzv ada`b wlaebd`fefstazad F] bt b ocfefobccv zaca}bet disbga im bt 1g)kg)`fe%:4? Di~b`fea# wlae bd`fefstazad bt 1g)kg)`fe F]# feozabsad bc}aicbz mcqfd ocabzbeoa febe fsicbtad ~azmqsad zbt `idac jv feozabsfeg tlabotf}ftv im sidfq )~itbssfq` bdaeisfea tzf~lis-~lbtbsa ~q`~s%:44 Tlqs# ocfefobccv b}bfcbjca }bsibo-tf}a bgaets oiqcd ja qsamqc fe si`a ~btfaets wftl~qc`iebzv ada`b ti feozabsa zbtas im bc}aicbz mcqfdocabzbeoa%

    Aelbeoad Za~bfz im tla Bc}aicbz A~ftlacfbc Jbz-zfaz8 Iea im tla lbcc`bzks im BCF)BZD_ fs dfszq~-tfie im tla bc}aicbz a~ftlacfq` wftl eaozisfs izb~i~tisfs im bc}aicbz tv~a F oaccs% Ammaotf}a zaoi}azvim cqeg mqeotfie da~aeds ie zaoiestftqtfie im tlabc}aicbz stzqotqza fe tla fehqzad cqeg bzabs% Bs ~bzt imtla za~bfz ~zioass# bc}aicbz a~ftlacfbc tv~a FF oaccs~zicfmazbta bed ~zi}fda b ~zi}fsfiebc eaw a~ftlacfbcjbzzfaz%:41 Fdabccv# bc}aicbz a~ftlacfbc ~zicfmazbtfiewiqcd iooqz wftl b `fef`bc mfjzitfo zas~iesa% Liw-a}az# fe si`a ~btfaets# botf}btad `vimfjzijcbsts mzi`tla fetazstftfq` `fgzbta feti tla bc}aicf tlziqgl gb~sfe tla jbsa`aet `a`jzbea bed bttbol ti tla cq`febcsqzmboa im db`bgad bc}aicbz `a`jzbeas% @vimfjzi-jcbst za~cfobtfie bt tla bfz-cqeg fetazmboa `bv obqsamfjzisfeg bc}aicftfs bed ijcftazbtfie im gbs a|olbegaqefts%:4=#:47 Tlfs ~zioass fs oietziccad jv aedigaeiqs`adfbtizs sqol bs ~cbtacat-dazf}ad gziwtl mbotiz beditlaz ~a~tfdas%:47#:4< Ocfefobc a}fdaeoa:46 sqggaststlbt oiccbgae svetlasfs iooqzs fe tla abzcv ~lbsa im

    BCF)BZD_% Tlqs# tla sa}aza mfjzi~zicfmazbtf}a za-s~iesa fe si`a ~btfaets fe tla cbta-~lbsa im BCF)BZD_ `bv ja dataz`fead abzcv fe tla oiqzsa im cqegfehqzv%

    Tla ~zi}fsfie im b eaw a~ftlacfbc jbzzfaz wftl tv~aFF oaccs `bv lb}a jaeamfofbc ammaots fe bddftfie tizastizbtfie im tla bfz-cfrqfd fetazmboa% Miz a|b`~ca#za-a~ftlacfbcfxbtfie im tla bfz-cqeg fetazmboa fs bssi-ofbtad wftl b gzbdqbc zagzassfie im fetzb-bc}aicbzgzbeqcbtfie tfssqa%:47 Bcsi# tla zbta im bc}aicbz a~f-tlacfbc mcqfd ocabzbeoa fe tla sqjboqta ~lbsa imjcai`vofe-fedqoad BCF fe zbts wbs feozabsad jv 2>>! i}az jbsacfea ca}acs%:1> Aelbeoad bc}aicbzmcqfd ocabzbeoa da~aeds fe ~bzt ie a|taesf}a ~zicfm-azbtfie im bc}aicbz a~ftlacfbc tv~a FF oaccs%

    _tqdfas:12:1? sqggast tlbt la~btiovta gziwtl mbo-tiz bed kazbtfeiovta gziwtl mbotiz bza `bhiz `fti-gaes miz bc}aicbz a~ftlacfbc tv~a FF oaccs# bed fetzbtzb-olabc ~zatzabt`aet im zbts wftl kazbtfeiovta gziwtlmbotiz ,1 `g)kg& ~zfiz ti fedqotfie im cqeg fehqzv wftllv~azi|fb# bofd festfccbtfie# jcai`vofe# iz zbdfbtfiedaozabsad sa}azftv im fehqzv% Tla `aolbefs` im~zitaotfie `bv ja dqa ti feozabsad bc}aicbz mcqfdtzbes~izt saoiedbzv ti tla feozabsad eq`jazs imbc}aicbz tv~a FF oaccs bed jv itlaz `aolbefs`s#feocqdfeg feozabsad zacabsa im sqzmboa-botf}a `btazfbciz `iza zasfstbeoa im tla bc}aicbz a~ftlacfq` tifehqzv%

    Oieocqsfie

    Tla daozabsa fe BCF)BZD_ `iztbcftv za~iztadsfeoa 2662:14#:11 fs bttzfjqtbjca ti f`~zi}a`aets fe`bev bs~aots im obza# sqol bs }aetfcbtiz `bebga-`aet# dfbgeisfs bed tzabt`aet im femaotfies# bedeqtzftfiebc sq~~izt% Liwa}az# `iztbcftv fs stfcc lfgl#bed si`a sqz}f}izs sqmmaz wftl }bzfiqs sarqacba miz`ietls bmtaz zaoi}azv mzi` ozftfobc fcceass%:1=#:17

    Tlqs# mqztlaz f`~zi}a`aets fe tzabt`aet bzaeaadad%

    F`~zi}ad qedazstbedfeg im tla ~btligaeasfs imBCF)BZD_ lbs cad ti f`~iztbet bd}beoas fe tlatzabt`aet im BCF)BZD_# ~bztfoqcbzcv fe tla bzab im}aetfcbtiz-bssiofbtad cqeg fehqzv%: _tbedbzd sq~~izt-f}a obza miz ~btfaets wftl BCF)BZD_ sliqcd eiwfeocqda b ~zitaotf}a }aetfcbtizv stzbtagv wftl ciwtfdbc }icq`a }aetfcbtfie jv tla ~zitioic da}aci~ad jvtla EFL BZD_ Eatwizk%?> Mqztlaz zamfea`aets imtla ~zitioic miz `aolbefobc }aetfcbtfie wfcc iooqz bsbddftfiebc ocfefobc tzfbcs bza oi`~catad% Fe bddftfie#ei}ac `idas im `aolbefobc }aetfcbtfie bza jafegstqdfad bed `bv bqg`aet stbedbzd tlazb~v fe tlamqtqza% Bctliqgl `ist betf-femcb``btizv stzbtagfaslb}a jaae dfsb~~ifetfeg fe ocfefobc tzfbcs# mqztlaztzfbcs bza qedazwbv ti tast tla ammfobov im cbta oiztf-

    2?=> Za}faws

    Oi~vzfglt :>>2 B`azfobe Oiccaga im Olast ^lvsfofbesjv gqast ie Bqgqst :6# :>>6www%olasthiqzebc%izgDiwecibdad mzi`

    http://www.chestjournal.org/http://www.chestjournal.org/http://www.chestjournal.org/
  • 8/9/2019 Acute Respiratory Distress Syndrome 4

    16/23

    oistazifds bed itlaz b~~zibolas ti `idqcbtfie imfemcb``btfie fe BCF)BZD_% Mqztlaz`iza# tla za-oaet sqooass im botf}btad ~zitafe O tlazb~v miz sa}azasa~sfs:>=#:>7 `bkas ft cfkacv tlbt tla sa}azftv im sa~sfsbssiofbtad wftl BCF)BZD_ wfcc ja bttaeqbtad jv tlfseaw tlazb~v% Fe bddftfie# jbsfo zasabzol oietfeqas tidzf}a tla da}aci~`aet im eaw tzabt`aet stzbtagfas%Be a|oftfeg eaw bzab im zasabzol fs tla `idqcbtfie imbc}aicbz a~ftlacfbc mqeotfie bed labcfeg tlbt `bv~zi}fda be f`~iztbet eaw dfzaotfie miz tzabt`aet imBCF)BZD_%

    BOKEIWCADG@AET8 Wa b~~zaofbta tla bssfstbeoa im Za-jaoob Ocamm fe ~za~bzfeg tlfs bztfoca%

    Zamazaeoas

    2 Bsljbqgl DG# Jfgaciw DJ# ^attv TC# at bc% Boqta zas~fzb-tizv dfstzass fe bdqcts% Cbeoat 26=7; :8?26 ?:?

    : Wbza CJ# @bttlbv @B% Tla boqta zas~fzbtizv dfstzasssvedzi`a% E Aegc H @ad :>>>; ?4:82??4 2?46

    ? Bjzblb` A# @bttlbv @B# Dfebzacci OB# at bc% Oiesaesqsoiemazaeoa damfeftfies miz sa~sfs# sa~tfo sliok# boqta cqegfehqzv# bed boqta zas~fzbtizv dfstzass svedzi`a8 tf`a miz bzaa}bcqbtfie% Ozft Obza @ad :>>>; :>>; 21712=:6

    7 Cqoa H@% Boqta cqeg fehqzv bed tla boqta zas~fzbtizv

    dfstzass svedzi`a% Ozft Obza @ad 266 Tla BZD_ Eatwizk% ]aetfcbtfie wftl ciwaz tfdbc }icq`as bsoi`~bzad wftl tzbdftfiebc tfdbc }icq`as miz boqta cqeg fehqzvbed tla boqta zas~fzbtizv dfstzass svedzi`a% E Aegc H @ad

    :>>>; ?4:82?>22?>

  • 8/9/2019 Acute Respiratory Distress Syndrome 4

    17/23

    bed ~zbotfoas im `aolbefobc }aetfcbtfie% Eaw Vizk# EV8@oGzbw-Lfcc# 2664; 824:124?2

    42 Kijbvbslf T# _lfkf V# @avzfok J# at bc% _f qctbeaiqsa|~isqza im slaa~ ti aediti|fe bed 2>>! i|vgae% B` Za}Zas~fz Dfs 2662; 2448=>> =>1

    4: Mzbek C# Zijazts ZH% Aediti|fe ~zitaotfie bgbfest i|vgae-fedqoad boqta bed olziefo cqeg fehqzv% H B~~c ^lvsfic,Zas~fz Ae}fzie A|az ^lvsfic& 2676; 4781771782?;2=28241> 24148

  • 8/9/2019 Acute Respiratory Distress Syndrome 4

    18/23

    svedzi`a% Fe8 Kfeeav H@# Tqokaz LE# ads% Izgbe `atbj-icfs` bed eqtzftfie8 fdabs miz mqtqza ozftfobc obza% Eaw Vizk#EV8 Zb}ae ^zass# 2664; 417 4

    7< _lia bkaz WO# B~~ac ^C# Jfsli~ @L% Ta`~izbc ~bttazesim jciid }icq`a# la`idveb`fos# bed i|vgae tzbes~izt fe~btligaeasfs bed tlazb~v im ~isti~azbtf}a bdqct zas~fzbtizvdfstzass svedzi`a% Eaw Lizfx 266?; 281::1?7

    76 Zqssacc HB# ^lbeg ^T% Tla i|vgae dacf}azv)oiesq`~tfieoietzi}azsv8 b~~zibolas ti `bebga`aet im tla ozftfobccv fcc%

    B` H Zas~fz Ozft Obza @ad 2664; 24681??1?7 Dbetxkaz DZ# Mizas`be J# Gqtfazzax G% I|vgae sq~~cv bed

    qtfcfxbtfie zacbtfieslf~s8 b zaa}bcqbtfie% B` Za} Zas~fz Dfs2662; 24?8=71 =76

    82:264276? Lbesae-Mcbsolae H# Oiwae H# Zb~s AO% Eaqzi`qsoqcbz

    jciokbda fe tla FOQs8 `iza tlbe wa jbzgbfead miz% B` Za}Zas~fz Dfs 266?; 2478:?4:?=

    64 Lbcc HJ# _ol`fdt GB# Wiid CDL# ads% zfeof~cas im ozftfobcobza% Eaw Vizk# EV8 @oGzbw-Lfcc# 2667

    61 Tijfe @H% ^zfeof~cas bed ~zbotfoa im fetaesf}a obza `ief-tizfeg% Eaw Vizk# EV8 @oGzbw-Lfcc# 266 ) 4 ) IOTIJAZ# :>>2 2?=?

    Oi~vzfglt :>>2 B`azfobe Oiccaga im Olast ^lvsfofbesjv gqast ie Bqgqst :6# :>>6www%olasthiqzebc%izgDiwecibdad mzi`

    http://www.chestjournal.org/http://www.chestjournal.org/http://www.chestjournal.org/
  • 8/9/2019 Acute Respiratory Distress Syndrome 4

    19/23

    227 B`azfobe Tlizbofo _iofatv% Lis~ftbc-borqfzad ~eaq iefbfe bdqcts8 dfbgeisfs# bssass`aet im sa}azftv# feftfbc betf`fozi-jfbc tlazb~v# bed ~za}aetbtf}a stzbtagfas; b oiesaesqs stbta-`aet% B` H Zas~fz Ozft Obza @ad 2661; 21?8272227:1

    22< Oazzb MJ# Jaeftax @Z# Jcbokjqze GC# at bc% B~~cfadeqtzftfie fe FOQ ~btfaets8 b oiesaesqs stbta`aet im tlaB`azfobe Oiccaga im Olast ^lvsfofbes% Olast 2667; 22287=6 77> 21>:2:> Bc}azdv HO# Bivs A# @iss G_% T^E ~zi`itas jbotazfbc

    tzbesciobtfie mzi` tla gqt% _qzgazv 2626

    2:1 Oazzb MJ# @o^lazsie H^# Kiestbetfefdas ME# at bc% Aetazbceqtzftfie dias eit ~za}aet `qctf~ca izgbe mbfcqza svedzi`a,@IM_& bmtaz sa~sfs% _qzgazv 266 24:>

    2:6 Miwcaz BB FFF# Lb``be ZM# Giid HT% Bdqct zas~fzbtizvdfstzass svedzi`a8 zfsk wftl oi``ie ~zadfs~isftfies% BeeFetaze @ad 26 Oizjzfdga TO# Wiid CD# Ozbwmizd G^# at bc% Bd}azsaammaots im cbzga tfdbc }icq`a bed ciw ^AA^ fe obefea bofdbs~fzbtfie% B` Za} Zas~fz Dfs 266>; 24:8?22?21

    2?2 @qsoadaza HG# @qccae HJ# Gbe K# at bc% Tfdbc }aetfcbtfie btciw bfzwbv ~zassqzas obe bqg`aet cqeg fehqzv% B` H Zas~fzOzft Obza @ad 2664; 24682?:72??4

    2?: Giid`be CZ# Mq`bgbccf Z# Tbgcfbjqa ^# at bc% Bdqct

    zas~fzbtizv dfstzass svedzi`a dqa ti ~qc`iebzv bed a|-tzb~qc`iebzv obqsas8 OT# ocfefobc# bed mqeotfiebc oizzacb-tfies% Zbdficigv 2666; :2?814111:

    2?? Gbttfeief C# ^acisf ^# _qtaz ^@# at bc% Boqta zas~fzbtizvdfstzass svedzi`a obqsad jv ~qc`iebzv bed a|tzb~qc`iebzvdfsabsa8 dfmmazaet svedzi`as9 B` H Zas~fz Ozft Obza @ad26611

    2?7 Betieaccf @# Oietf G# Ziooi @# at bc% B oi`~bzfsie imeiefe}bsf}a ~isftf}a-~zassqza }aetfcbtfie bed oie}aetfiebc`aolbefobc }aetfcbtfie fe ~btfaets wftl boqta zas~fzbtizvmbfcqza% E Aegc H @ad 266

  • 8/9/2019 Acute Respiratory Distress Syndrome 4

    20/23

    ~az`fssf}a lv~azob~efb% B` H Zas~fz Ozft Obza @ad 2666;216846 14

    21= @fzi B@# Limm`be CB# Tbsitb MH# at bc% Tzbolabc gbsfesqmmcbtfie f`~zi}as }aetfcbtizv ammfofaeov dqzfeg `atlb-olicfea-fedqoad jzieolis~bs`% H Ozft Obza 2667; 2:82?:2

    217 Eblq` B# Zb}aesozbmt _B# Ebkis G# at bc% Tzbolabc gbsfesqmmcbtfie dqzfeg ~zassqza-oietzic }aetfcbtfie8 ammaot imobtlataz ~isftfie# dfb`ataz# bed mciw zbta% B` Za} Zas~fzDfs 266:; 24=82422242

    216 Viqeas @# ^qddv B# Zijazts D# at bc% ^zi~iztfiebc bssfst}aetfcbtfie8 zasqcts im be feftfbc ocfefobc tzfbc% B` Za} Zas~fzDfs 266:; 24182:22:6

    2=> @bzov TW# @bzfef HH% Fe}azsa zbtfi }aetfcbtfie fe BZD_8zbtfiebca bed f`~ca`aetbtfie% Olast 2662; 2>>8464 1>4

    2=2 Tlbzzbtt Z_# Bccae Z^# Bcjaztsie TA% ^zassqza oietziccadfe}azsa zbtfi }aetfcbtfie fe sa}aza bdqct zas~fzbtizv mbfcqza%Olast 26; ?4:824722477

    2=6 Diwes HJ# _tiok @O% Bfzwbv ~zassqza zacabsa }aetfcbtfie8 beaw oieoa~t fe }aetfcbtizv sq~~izt [adftizfbcP% Ozft Obza@ad 26 Zbsbeae H# Obea ZD# Diwes HJ# at bc% Bfzwbv ~zassqzazacabsa }aetfcbtfie dqzfeg boqta cqeg fehqzv8 b ~zis~aotf}a`qctfoaetaz tzfbc% Ozft Obza @ad 2662; 2682:?4 2:42

    272 Zbsbeae H% Bfzwbv ~zassqza zacabsa }aetfcbtfie% Fe8 Tijfe @#ad% ^zfeof~cas bed ~zbotfoa im `aolbefobc }aetfcbtfie% @bv-

    wiid# FC8 @oGzbw-Lfcc# 2664; ?42?4- ti 2?1>-gzb`fembets wftl zas~fzbtizv dfstzass svedzi`a% H ^adfbtz 2662;221

    274 Cawfs HM# Hija BL% _qzmbotbet bed tla bdqct zas~fzbtizvdfstzass svedzi`a [~qjcfslad azzbtq` b~~abzs fe B` Za}Zas~fz Dfs 266?; 24782>=212>218261:>:

    277 Bexqati B# Jbqgl`be Z^# Gqetq~bccf KK# at bc% Bazisicfxadsqzmbotbet fe bdqcts wftl sa~sfs-fedqoad boqta zas~fzbtizvdfstzass svedzi`a% E Aegc H @ad 266=; ??48242724:2

    27< Mqckazsie WH# @boFetvza E# _tb`caz H# at bc% ^btligaeasfsbed tzabt`aet im tla bdqct zas~fzbtizv dfstzass svedzi`a%Bzol Fetaze @ad 266=; 21=8:6 ?? =2:

    2 Xb~ic W@# _efdaz @T# Lfcc HD# at bc% A|tzboiz~izabc`a`jzbea i|vgaebtfie fe sa}aza boqta zas~fzbtizv mbfcqza8 bzbedi`fxad ~zis~aotf}a stqdv% HB@B 2676; :4:8:26?:26=

    21

    2>< 2>27

    2

  • 8/9/2019 Acute Respiratory Distress Syndrome 4

    21/23

    bssiofbtad gbs a|olbega f`~zi}as i|vgaebtfie# cqeg `a-olbefos# bed sqz}f}bc fe b `idac im bdqct zas~fzbtizv dfstzasssvedzi`a% Ozft Obza @ad 266=; :484== 474

    26= Tqtqeoq B_# Mbftlmqcc E_# Cbol`bee J% Fetzbtzbolabc ~az-mcqiziobzjie bd`fefstzbtfie oi`jfead wftl `aolbefobc }ae-tfcbtfie fe a|~azf`aetbc zas~fzbtizv dfstzass svedzi`a8 disa-da~aedaet f`~zi}a`aet im gbs a|olbega% Ozft Obza @ad266?; :286=:6=6

    267 Lfzsolc ZJ# Tiicav Z# ^bzaet B# at bc% A}bcqbtfie im gbs

    a|olbega# ~qc`iebzv oi`~cfbeoa# bed cqeg fehqzv dqzfegtitbc bed ~bztfbc cfrqfd }aetfcbtfie fe tla boqta zas~fzbtizvdfstzass svedzi`a% Ozft Obza @ad 266=; :482>>22>>< 2:24

    266 Lfzsolc ZJ# ^zbefkimm T# Wfsa O# at bc% Feftfbc a|~azfaeoawftl ~bztfbc cfrqfd }aetfcbtfie fe bdqct ~btfaets wftl tla boqtazas~fzbtizv dfstzass svedzi`a% HB@B 266=; :718?

  • 8/9/2019 Acute Respiratory Distress Syndrome 4

    22/23

    wftl ~eaq`iefb bed bdqct zas~fzbtizv dfstzass svedzi`a%Femaot F``qe 266?; =28411? 4116

    :?2 Dieeaccv TH# @abda ^# Hbgacs @# at bc% Ovtikfea# oi`~ca-`aet# bed aediti|fe ~zimfcas bssiofbtad wftl tla da}aci~-`aet im tla bdqct zas~fzbtizv dfstzass svedzi`a bmtaz sa}azafehqzv% Ozft Obza @ad 2664; ::87=< 77=

    :?: Dieeaccv _O# _tzfataz Z@# Kqekac _C# at bc% Fetazcaqkfe-= 12:

    :?< Ob`~jacc BZ# Mickassie LG# Jaztlfbq`a V# at bc% Bc}aicbzmcqfd ocabzbeoa ~azsfsts fe tla ~zasaeoa im `idazbta camtbtzfbc lv~aztaesfie fe slaa~% H B~~c ^lvsfic 2666; ; 6

    :14 @fcjazg HB# Db}fs DZ# _tafejazg K^# at bc% F`~zi}adsqz}f}bc im ~btfaets wftl boqta zas~fzbtizv dfstzass svedzi`a,BZD_&8 26= ?>6

    :11 Bjac _HO# Mfeeav _H# Jzatt _H# at bc% Zadqoad `iztbcftv febssiofbtfie wftl tla boqta zas~fzbtizv dfstzass svedzi`a,BZD_&% Tlizb| 266 22: ) 4 ) IOTIJAZ# :>>2 2?=7

    Oi~vzfglt :>>2 B`azfobe Oiccaga im Olast ^lvsfofbesjv gqast ie Bqgqst :6# :>>6www%olasthiqzebc%izgDiwecibdad mzi`

    http://www.chestjournal.org/http://www.chestjournal.org/http://www.chestjournal.org/
  • 8/9/2019 Acute Respiratory Distress Syndrome 4

    23/23

    DIF 2>%2?7%4%2?47:>>2;2:>; 2?47-2?=7Olast

    Ziv G% Jziwaz# Cizzbfea J% Wbza# V}as Jaztlfbq`a bed @folbac B% @bttlbv

    (Tzabt`aet im BZD_

    Bqgqst :6# :>>6Tlfs femiz`btfie fs oqzzaet bs im

    - _az}foasQ~dbtad Femiz`btfie

    ltt~8))www%olasthiqzebc%izg)oietaet)2:>)4)2?47%mqcc%lt`clfgl-zasicqtfie mfgqzas# obe ja miqed bt8Q~dbtad Femiz`btfie bed saz}foas# feocqdfeg

    Zamazaeoas

    lt`c/zamcfst2ltt~8))www%olasthiqzebc%izg)oietaet)2:>)4)2?47%mqcc%booassad mzaa bt8Tlfs bztfoca oftas ::1 bztfocas# 227 im wlfol obe ja

    Oftbtfies

    lt`c/zacbtadqzcs

    ltt~8))www%olasthiqzebc%izg)oietaet)2:>)4)2?47%mqcc%bztfocas8Tlfs bztfoca lbs jaae oftad jv 2? LfglWfza-listad

    I~ae Booassi~tfieMzaacv b}bfcbjca iecfea tlziqgl OLA_T i~ae booass

    ^az`fssfies - Cfoaesfeg

    ltt~8))www%olasthiqzebc%izg)sfta)`fso)za~zfets%|lt`c,mfgqzas# tbjcas& iz fe fts aetfzatv obe ja miqed iecfea bt8Femiz`btfie bjiqt za~zidqofeg tlfs bztfoca fe ~bzts

    Za~zfetsltt~8))www%olasthiqzebc%izg)sfta)`fso)za~zfets%|lt`c

    Femiz`btfie bjiqt izdazfeg za~zfets obe ja miqed iecfea8

    A`bfc bcaztfeg saz}foa

    iecfea bztfoca%bztfoca% _fge q~ fe tla ji| bt tla ti~ zfglt oizeaz im tlaZaoaf}a mzaa a`bfc bcazts wlae eaw bztfocas ofta tlfs

    miz`btF`bgas fe iwaz^ifet

    miz`bt% _aa bev iecfea bztfoca mfgqza miz dfzaotfies%diwecibdad miz tabolfeg ~qz~isas fe ^iwaz^ifet scfdaMfgqzas tlbt b~~abz fe OLA_T bztfocas obe ja

    http://www.chestjournal.org/content/120/4/1347.full.htmlhttp://www.chestjournal.org/content/120/4/1347.full.htmlhttp://www.chestjournal.org/content/120/4/1347.full.htmlhttp://www.chestjournal.org/content/120/4/1347.full.html#ref-list-1http://www.chestjournal.org/content/120/4/1347.full.html#ref-list-1http://www.chestjournal.org/content/120/4/1347.full.html#ref-list-1http://www.chestjournal.org/content/120/4/1347.full.html#related-urlshttp://www.chestjournal.org/content/120/4/1347.full.html#related-urlshttp://www.chestjournal.org/content/120/4/1347.full.html#related-urlshttp://www.chestjournal.org/site/misc/reprints.xhtmlhttp://www.chestjournal.org/site/misc/reprints.xhtmlhttp://www.chestjournal.org/site/misc/reprints.xhtmlhttp://www.chestjournal.org/site/misc/reprints.xhtmlhttp://www.chestjournal.org/site/misc/reprints.xhtmlhttp://www.chestjournal.org/site/misc/reprints.xhtmlhttp://www.chestjournal.org/site/misc/reprints.xhtmlhttp://www.chestjournal.org/site/misc/reprints.xhtmlhttp://www.chestjournal.org/content/120/4/1347.full.html#related-urlshttp://www.chestjournal.org/content/120/4/1347.full.html#ref-list-1http://www.chestjournal.org/content/120/4/1347.full.html