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

Research output: Contribution to journalArticle

155 Citations (Scopus)

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 - 1976

Fingerprint

Adult Respiratory Distress Syndrome
Extracorporeal Membrane Oxygenation
Positive-Pressure Respiration
Survivors
Fibrosis
Biopsy
Lung
Ventilation
Autopsy
Edema
Perfusion
Gases
Hypoxia
Hemorrhage
Pressure

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., ... Hill, J. D. (1976). Pathologic features and mechanisms of hypoxemia in adult respiratory distress syndrome. American Review of Respiratory Disease, 114(2), 267-284.

Pathologic features and mechanisms of hypoxemia in adult respiratory distress syndrome. / Lamy, M.; Fallat, R. J.; Koeniger, E.; Dietrich, H. P.; Ratliff, J. L.; Eberhart, R. C.; Tucker, H. J.; Hill, J. D.

In: American Review of Respiratory Disease, Vol. 114, No. 2, 1976, p. 267-284.

Research output: Contribution to journalArticle

Lamy, M, Fallat, RJ, Koeniger, E, Dietrich, HP, Ratliff, JL, Eberhart, RC, Tucker, HJ & Hill, JD 1976, 'Pathologic features and mechanisms of hypoxemia in adult respiratory distress syndrome', American Review of Respiratory Disease, vol. 114, no. 2, pp. 267-284.
Lamy M, Fallat RJ, Koeniger E, Dietrich HP, Ratliff JL, Eberhart RC et al. Pathologic features and mechanisms of hypoxemia in adult respiratory distress syndrome. American Review of Respiratory Disease. 1976;114(2):267-284.
Lamy, M. ; Fallat, R. J. ; Koeniger, E. ; Dietrich, H. P. ; Ratliff, J. L. ; Eberhart, R. C. ; Tucker, H. J. ; Hill, J. D. / Pathologic features and mechanisms of hypoxemia in adult respiratory distress syndrome. In: American Review of Respiratory Disease. 1976 ; Vol. 114, No. 2. pp. 267-284.
@article{d73f8a4737c94b9b8b8ab3980506838e,
title = "Pathologic features and mechanisms of hypoxemia in adult respiratory distress syndrome",
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.",
author = "M. Lamy and Fallat, {R. J.} and E. Koeniger and Dietrich, {H. P.} and Ratliff, {J. L.} and Eberhart, {R. C.} and Tucker, {H. J.} and Hill, {J. D.}",
year = "1976",
language = "English (US)",
volume = "114",
pages = "267--284",
journal = "American Journal of Respiratory and Critical Care Medicine",
issn = "1073-449X",
publisher = "American Thoracic Society",
number = "2",

}

TY - JOUR

T1 - Pathologic features and mechanisms of hypoxemia in adult respiratory distress syndrome

AU - Lamy, M.

AU - Fallat, R. J.

AU - Koeniger, E.

AU - Dietrich, H. P.

AU - Ratliff, J. L.

AU - Eberhart, R. C.

AU - Tucker, H. J.

AU - Hill, J. D.

PY - 1976

Y1 - 1976

N2 - 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.

AB - 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.

UR - http://www.scopus.com/inward/record.url?scp=0017159946&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=0017159946&partnerID=8YFLogxK

M3 - Article

C2 - 788563

AN - SCOPUS:0017159946

VL - 114

SP - 267

EP - 284

JO - American Journal of Respiratory and Critical Care Medicine

JF - American Journal of Respiratory and Critical Care Medicine

SN - 1073-449X

IS - 2

ER -