Am. J. Respir. Crit. Care Med., Volume 158, Number 1, July 1998, 3-11

Acute Respiratory Distress Syndrome Caused by Pulmonary and Extrapulmonary Disease
Different Syndromes?

LUCIANO GATTINONI, PAOLO PELOSI, PETER M. SUTER, ALESSIA PEDOTO, PAOLA VERCESI, and ALFREDO LISSONI

Istituto di Anestesia e Rianimazione, Universita' di Milano and Servizio di Anestesia e Rianimazione, Ospedale Maggiore IRCCS, Milano, Italy; and Division of Surgical Intensive Care, University Hospital of Geneva, Geneva, Switzerland

To assess the possible differences in respiratory mechanics between the acute respiratory distress syndrome (ARDS) originating from pulmonary disease (ARDS_p) and that originating from extrapulmonary disease (ARDS_exp) we measured the total respiratory system (Est,rs), chest wall (Est,w) and lung (Est,L) elastance, the intra-abdominal pressure (IAP), and the end-expiratory lung volume (EELV) at 0, 5, 10, and 15 cm H₂O positive end-expiratory pressure (PEEP) in 12 patients with ARDS_p and nine with ARDS_exp. At zero end-expiratory pressure (ZEEP), Est,rs and EELV were similar in both groups of patients. The Est,L, however, was markedly higher in the ARDS_p group than in the ARDS_exp group (20.2 ± 5.4 versus 13.8 ± 5.0 cm H₂O/L, p < 0.05), whereas Est,w was abnormally increased in the ARDS_exp group (12.1 ± 3.8 versus 5.2 ± 1.9 cm H₂O/L, p < 0.05). The IAP was higher in ARDS_exp than in ARDS_p (22.2 ± 6.0 versus 8.5 ± 2.9 cm H₂O, p < 0.01), and it significantly correlated with Est,w (p < 0.01). Increasing PEEP to 15 cm H₂O caused an increase of Est,rs in ARDS_p (from 25.4 ± 6.2 to 31.2 ± 11.3 cm H₂O/L, p < 0.01) and a decrease in ARDS_exp (from 25.9 ± 5.4 to 21.4 ± 55.5 cm H₂O/L, p < 0.01). The estimated recruitment at 15 cm H₂O PEEP was 0.031 ± 0.092 versus 0.293 ± 0.241 L in ARDS_p and ARDS_exp, respectively (p < 0.01). The different respiratory mechanics and response to PEEP observed are consistent with a prevalence of consolidation in ARDS_p as opposed to prevalent edema and alveolar collapse in ARDS_exp.

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