The adult respiratory syndrome.

The Adult Respiratory Distress Syndrome remains one of the most lethal complications in both surgical and medical intensive care units. Mortalities of 50 to 80 per cent are still reported in recent reviews. Many risk factors have been associated with an increased incidence of ARDS, but sepsis and direct pulmonary injury from aspiration, pulmonary contusion and near drowning are most commonly identified. Studies of physiopathologic factors of ARDS implicate granulocyte aggregation with the formation of oxygen free radicals and other cellular and chemical mediators. Pharmacologic agents and high frequency positive pressure ventilation are presently being investigated, but the accepted form of therapy combines increased inspired oxygen tensions, positive end expiratory pressure and some form of mechanical ventilation, if necessary.