BMJ  2007;335:389-394 (25 August), doi:10.1136/bmj.39293.624699.AD

Clinical Review

Clinical Review

Acute respiratory distress syndrome

Department of Critical Care, Imperial College School of Medicine, Royal Brompton Hospital, London SW3 6NP

The first 150 words of the full text of this article appear below.

Summary points • Acute lung injury and its extreme manifestation, the acute respiratory distress syndrome, complicate a variety of serious medical and surgical conditions, not all of which affect the lung directly • Dyspnoea is the commonest presenting symptom; clinical signs are those of pulmonary oedema • Early admission to intensive care is needed; the precipitating illness should be identified and managed aggressively • Protective techniques of mechanical ventilatory support reduce mortality • Rigorous application of general supportive measures is likely to improve outcome • Non-ventilatory adjuncts to gas exchange generally improve oxygenation but do not reduce mortality • Although death rates are falling, long term debility in survivors is considerable

Why do I need to know about acute respiratory distress syndrome?

Acute respiratory distress syndrome is the extreme manifestation of acute lung injury. Both these conditions complicate many medical and surgical conditions, not all of which affect the lung directly and are therefore encountered by clinicians working outside the critical care setting . . . [Full text of this article]

How are these conditions defined?

Box 1 Definition criteria for acute lung injury and acute respiratory distress syndrome¹

How often is it encountered?

How is acute lung injury recognised?

Box 2 Acute lung injury: differential diagnoses

What is the pathophysiology of acute lung injury?

What investigations should be performed?

How should these patients be managed?

General supportive measures

Nutrition
Fluid management
Glycaemic control

Mechanical ventilation

Lung protection
Positive end expiratory pressure
Prone ventilation
Other ventilatory techniques

Non-ventilatory adjuncts to gas exchange

Inhaled nitric oxide
Nebulised prostacyclin
Surfactant
Extracorporeal gas exchange

Pharmaceutical interventions

Corticosteroids
Other pharmacotherapies

When is a patient ready to wean from mechanical ventilation?

How many patients survive and what is their quality of life?

Box 3 Problems encountered after survival from acute respiratory distress syndrome³⁰
Sources and selection criteria
Additional educational resources
Resources for health professionals
Resources for patients
Unanswered research questions and ongoing research
New registered trials of potential pharmacological interventions in patients with acute lung injury registered at Clinical Trials.gov
A patient's perspective

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