[The adult respiratory distress syndrome. Clinical signs, radiology and biological data (author's transl)].

The etiology of shocklung is diverse. All causes lead to a lesion of the alveolar-capillary membrane with interstitial and subsequent alveolar edema. The clinical manifestations, although variable, are progressive and can be divided into 3 stages, which are the expression of a decrease in pulmonary compliance and of hypoxemia due to a ventilation-perfusion defect (shunt effect). The diagnosis of shocklung must be differentiated from pulmonary edema of cardiac origin by right heart catheterization and demonstrate a normal capillary pressure, a pulmonary hypertension with increased pulmonary resistance and a normal or increased cardiac output. A decreased PaO2 is the first sign of a ventilation-perfusion imbalance. The problem of alveolar-capillary O2 transfer is better defined by the alveolar-arterial O2 difference, the calculation of quantity of the intrapulmonary shunt and the hyperoxia curve. The daily analysis of the hyperoxia curve allows for a better appreciation of the clinical status than the clinical and radiological signs. The prognosis of the shockening is poor inspite of better reanimation technics. The mortality is about 50% and depends on 3 factors: etiology, early diagnosis and correction of the primary insult.