The adult respiratory distress syndrome

Modern approaches to the therapy of septic shock

Bacteremia from gram-negative rods is a great cause of concern for hospital physicians today. Shock-complicating gram-negative sepsis has a mortality rate of 60% and above, despite early diagnosis and treatment. Intensive research efforts have shown new pathophysiological mechanisms and mediators involved in septic shock, with changes in recommended treatment protocols. In this report, the authors review the use of corticosteroids, fibronectin, naloxone hydrochloride, and immunotherapy, with emphasis on theoretical considerations and relevant clinical experience. Although these treatment methods may have been promising initially, data from large double-blind human trials are either lacking or unencouraging. While continued research and modern therapeutic approaches should improve future survival rates from septic shock, use of the therapies reviewed should be considered experimental at this time.

Adult respiratory distress syndrome: current concepts

Adult Respiratory Distress Syndrome (ARDS) is a common diagnosis in today's intensive care units, representing a final common pathway of lung response to a variety of disease states. Mortality rates remain excessively high, despite comprehensive monitoring and intensive treatment. The incidence, etiology, clinical features, pathology and pathophysiology of ARDS are reviewed, with special emphasis on current research regarding potentially injurious mediators and possible etiopathogenetic mechanisms. Current therapy is summarized, and new therapeutic modalities are assessed. It is hoped that increased knowledge and awareness of the various aspects of ARDS will lead to further understanding and better clinical results in patients with this syndrome.

Changes in lung ATP concentration in the rat after low-level phosgene exposure

Inhibition of mitochondrial respiratory activity and decreased lung adenosine triphosphate (ATP) concentration occur following exposure to 240 ppm.min phosgene. To determine the relationship between energy stores and the onset of phosgene-induced pulmonary edema, we measured the ATP concentration in rapidly frozen rat lung tissue before and during pulmonary edema. Male Sprague-Dawley rats were exposed to phosgene for four hours at concentrations of 0.05 to 1.0 ppm (12, 30, 60, 120, and 240 ppm.min). Lung wet and dry weight and ATP concentration were measured immediately after exposure and for three days postexposure. The accumulation of lavage fluid protein (LFP) was also measured as an index of damage or edema due to phosgene. Lung dry weight was significantly elevated one day postexposure to 0.5 ppm phosgene, while the LFP was elevated by 0.2 ppm phosgene. Time course studies at these doses of phosgene showed that decreased ATP levels preceded the onset of edema or increase in lung weight. The ATP values expressed on a per-lung basis showed that ATP levels were significantly lowered immediately following phosgene exposure, suggesting that the ATP changes were not the result of edema. This study is the first demonstration of a biochemical change that occurs following exposure to phosgene at a level significantly below the threshold limit value for this gas.