Pathologic features and mechanisms of hypoxemia in adult respiratory distress syndrome

M. Lamy, R. J. Fallat, E. Koeniger, H. P. Dietrich, J. L. Ratliff, R. C. Eberhart, H. J. Tucker, J. D. Hill

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Abstract

In 45 consecutive patients referred for severe hypoxemia (Pa(o) 2 < 100 mm Hg on positive endexpiratory pressure of 5 cm H 2O and fraction of inspired O 2 of 1.0), physiologic studies of gas exchange were correlated with pathologic features from 36 open lung biopsies and 15 autopsies. Three distinct groups were defined. Group 1 included 11 patients with the most severe hypoxia (Pa(o 2), 47 ± 12 mm Hg), minimal Pa(o) 2 response to a 10 cm H 2O increase in positive end expiratory pressure (+2.0 ± 4.0 mm Hg), and a fixed shunt at all fractions of inspired O 2. Pathologic study showed edema, exudation, and hemorrhage to the point of consolidation. In group 2 were 13 patients who had less severe hypoxia (Pa(o) 2, 60 ± 17 mm Hg) and a moderate Pa(o) 2 response to a 10 cm H 2O increase in positive end expiratory pressure (+15±8 mm Hg), but whose maximal response was slowly achieved (30 min to several hours). Pathologic examination showed extensive fibrosis. The 21 patients in group 3 had the least hypoxia (66 ± 15 mm Hg), and had a rapid and marked improvement Pa(o) 2 with a 10 cm H 2O increase in positive end expiratory pressure (+ 68 ± 59 mm Hg). Pathologic features were similar to but less severe than those in group 1. Venous admixture increased with decreasing inspired concentrations of O 2, indicating diffusion or ventilation perfusion abnormalities in groups 2 and 3. Prognosis was best for group 3, with 10 of 21 long term survivors. Two of 11 group 1 patients survived, but only after prolonged periods of extracorporeal membrane oxygenation. Despite biopsy evidence of extensive fibrosis, 3 of 13 in group 2 survived with moderate to good pulmonary function, including 1 survivor who had had extracorporeal membrane oxygenation. Such combined physiologic and pathologic studies are useful for optimal respiratory care, for prognosis, for development of indications for extracorporeal membrane oxygenation, and for better understanding of the pathophysiology of adult respiratory distress syndrome.

Original languageEnglish (US)
Pages (from-to)267-284
Number of pages18
JournalAmerican Review of Respiratory Disease
Volume114
Issue number2
StatePublished - Dec 1 1976

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ASJC Scopus subject areas

  • Pulmonary and Respiratory Medicine

Cite this

Lamy, M., Fallat, R. J., Koeniger, E., Dietrich, H. P., Ratliff, J. L., Eberhart, R. C., Tucker, H. J., & Hill, J. D. (1976). Pathologic features and mechanisms of hypoxemia in adult respiratory distress syndrome. American Review of Respiratory Disease, 114(2), 267-284.