A Brief Overview of Acute Respiratory Distress Syndrome
- Robert M. Hardaway
- World Journal of Surgery
OBJECTIVE To introduce a new concept in the etiology and treatment of traumatic and septic shock. It describes 3 types of shock: (1) hypovolemic shock, (2) traumatic shock, and (3) septic shock. BACKGROUND The mortality of septic shock in both total number and mortality rate has been increasing over the past 40 years despite major advances in diagnosis and treatment, including a number of "magic bullets." Trauma is the No. 1 cause of death in persons under the age of 44 and the No. 3 cause of all deaths. Traumatic shock has been assumed to be caused by hypovolemia; however, many traumatic shock patients die with a normal blood volume, usually after several days. Septic shock in pigs using an injection of killed Escherichia coli organisms produced disseminated intravascular coagulation (DIC). Control pigs treated with plasminogen activator survived. Septic shock in humans also treated with plasminogen activator showed excellent results. Traumatic shock studied in pigs showed excellent results with plasminogen activator. A normal blood volume was maintained with the use of intravenous fluids. Traumatic shock in humans also treated by plasminogen activator showed excellent results. The improvement in PaO2 and other parameters demonstrated in these studies provides a new possibility in the treatment of trauma and/or sepsis induced acute respiratory distress syndrome (ARDS). DIC is almost always present in traumatic and septic shock and probably in the course of ARDS and multiple organ failure. The DIC is probably initiated by tissue cell or bacterial cell destruction, which liberates a thrombogenic aminophospholipid that forms the inner layer of all cell walls.