Patricia R M Rocco1, Walter A Zin. 1. Laboratory of Pulmonary Investigation, Carlos Chagas Filho Biophysics Institute, Federal University of Rio de Janeiro, Centro de Ciências da Saúde, Rio de Janeiro, Brazil.
Abstract
PURPOSE OF REVIEW: Acute respiratory distress syndrome has been considered a morphologic and functional expression of lung injury caused by a variety of insults. Two distinct forms of acute respiratory distress syndrome/acute lung injury are described, because there are differences between pulmonary acute respiratory distress syndrome (direct effects on lung cells) and extrapulmonary acute respiratory distress syndrome (reflecting lung involvement in a more distant systemic inflammatory response). This article will focus on the differences in lung histology and morphology, respiratory mechanics, and response to ventilatory strategies and pharmacologic therapies in pulmonary and extrapulmonary acute respiratory distress syndrome. RECENT FINDINGS: Many researchers recognize that experimental pulmonary and extrapulmonary acute respiratory distress syndrome are not identical. In addition, clinical studies have described the detection of differences radiographically, functionally, and by analysis of the responses to therapeutic interventions (ventilatory strategies, positive end-expiratory pressure, prone position, drugs). However, there are contradictions among the different studies addressing these issues, which could be attributed to the fact that the distinction between pulmonary and extrapulmonary acute respiratory distress syndrome is not always clear and simple. Furthermore, there may be frequent overlapping in pathogenetic mechanisms and morphologic alterations. SUMMARY: The understanding of acute respiratory distress syndrome needs to take into account its origin. If each pathogenetic mechanism were to be considered, clinical management would be more precise, and probably the outcome could include real amelioration.
PURPOSE OF REVIEW: Acute respiratory distress syndrome has been considered a morphologic and functional expression of lung injury caused by a variety of insults. Two distinct forms of acute respiratory distress syndrome/acute lung injury are described, because there are differences between pulmonary acute respiratory distress syndrome (direct effects on lung cells) and extrapulmonary acute respiratory distress syndrome (reflecting lung involvement in a more distant systemic inflammatory response). This article will focus on the differences in lung histology and morphology, respiratory mechanics, and response to ventilatory strategies and pharmacologic therapies in pulmonary and extrapulmonary acute respiratory distress syndrome. RECENT FINDINGS: Many researchers recognize that experimental pulmonary and extrapulmonary acute respiratory distress syndrome are not identical. In addition, clinical studies have described the detection of differences radiographically, functionally, and by analysis of the responses to therapeutic interventions (ventilatory strategies, positive end-expiratory pressure, prone position, drugs). However, there are contradictions among the different studies addressing these issues, which could be attributed to the fact that the distinction between pulmonary and extrapulmonary acute respiratory distress syndrome is not always clear and simple. Furthermore, there may be frequent overlapping in pathogenetic mechanisms and morphologic alterations. SUMMARY: The understanding of acute respiratory distress syndrome needs to take into account its origin. If each pathogenetic mechanism were to be considered, clinical management would be more precise, and probably the outcome could include real amelioration.
Authors: Luiz Philippe da Silva Sergio; Andrezza Maria Côrtes Thomé; Larissa Alexsandra da Silva Neto Trajano; Solange Campos Vicentini; Adilson Fonseca Teixeira; Andre Luiz Mencalha; Flavia de Paoli; Adenilson de Souza da Fonseca Journal: Lasers Med Sci Date: 2018-10-08 Impact factor: 3.161