Pulmonary and extrapulmonary acute respiratory distress syndrome are different
Pulmonary and extrapulmonary acute respiratory distress syndrome are different
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DOI：
10.1183/09031936.03.00420803
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发表时间：
2003-08-01
影响因子：
24.3
通讯作者：
Gattinoni, L
中科院分区：
文献类型：
--
作者：
Pelosi, P;D'Onofrio, D;Gattinoni, L
急性呼吸窘迫综合征（ARDS）可由两种致病途径引起：直接损害肺细胞（肺ARDS（ARDSp））或间接损害肺细胞（肺外ARDS（ARDSexp））。这篇综述报道并讨论了ARDSp和ARDSexp在生化激活、组织学、形态学、呼吸力学和对不同呼吸策略的反应方面的差异。在ARDSp中，直接损伤主要影响肺泡上皮细胞的局部肺泡炎症反应，而在ARDSexp中，间接损伤通过炎症介质通过血流影响血管内皮细胞。ARDSp的放射学模式的特征是普遍的肺泡实变，而ARDSexp则是普遍的毛玻璃样混浊。在ARDSp中，肺弹性增加，而在ARDSexp中，胸壁和腹内胸部弹性增加。在ARDSext中，呼气末正压、复张动作和俯卧位的影响明显更大。尽管这两种类型的急性呼吸窘迫综合征具有不同的致病途径、形态学方面、呼吸力学以及对通气策略的不同反应，但目前尚不清楚这种区别是否真的可以改善结果。
Acute respiratory distress syndrome (ARDS) can be derived from two pathogenetic pathways: a direct insult on lung cells (pulmonary ARDS (ARDSp)) or indirectly (extrapulmonary ARDS (ARDSexp)). This review reports and discusses differences in biochemical activation, histology, morphological aspects, respiratory mechanics and response to different ventilatory strategies between ARDSp and ARDSexp. In ARDSp the direct insult primarily affects the alveolar epithelium with a local alveolar inflammatory response while in ARDSexp the indirect insult affects the vascular endothelium by inflammatory mediators through the bloodstream.Radiological pattern in ARDSp is characterised by a prevalent alveolar consolidation while the ARDSexp by a prevalent ground-glass opacification. In ARDSp the lung elastance, while in ARDSexp the chest wall and intra-abdominal chest elastance are increased. The effects of positive end-expiratory pressure, recruitment manoeuvres and prone position are clearly greater in ARDSexp.Although these two types of acute respiratory distress syndrome have different pathogenic pathways, morphological aspects, respiratory mechanics, and different response to ventilatory strategies, at the present, is still not clear, if this distinction can really ameliorate the outcome.