الفهرس 
IntroductionOnly 14 pages are availabe for public view
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Abstract
The acute respiratory distress syndrome (ARDS) is a major cause of acute respiratory failure. Its development leads to high rates of mortality, as well as short and long term complications. Therefore, early recognition of this syndrome and application of demonstrated therapeutic interventions are essential to change the natural course of this devastating entity. [1] There are many interesting historical medical events that correlated with or impacted the identification and management of ARDS leading to most new modern current concepts. [2] In 1821, Laennec described a new syndrome characterized by pulmonary edema without heart failure. The term “Acute Respiratory Distress Syndrome” was first used in 1967 to describe a distinct clinical entity characterized by acute abnormality of both lungs. [3] In 1970s, ARDS became increasingly recognized, but hydrostatic causes (e.g. volume overload) were difficult to rule out. The potential for confusion was so great that measurements of pulmonary artery wedge pressure became a very common means of diagnosis. [4] In 1988, Murray et al. introduced the lung injury score, which included chest radiograph, the ratio of the partial pressure of arterial oxygen and the fraction of inspired oxygen (PaO2/FiO2), total respiratory system compliance, and positive end-expiratory pressure (PEEP). [1] In 1992, the American European Consensus Conference (AECC) was charged with developing a standardized definition for ARDS to assist with clinical and epidemiologic research. [4] In 1994, the American European Consensus Conference (AECC) established criteria for the diagnosis of ARDS. However, as these clinical
criteria do not always correlate well with diffuse alveolar damage, which is
the typical pathologic ARDS feature, ARDS remains a syndrome associated
with multiple diagnoses, rather than a disease in itself. [3]
Imaging plays a key role in the diagnosis and follow-up of ARDS.
Chest radiography, bedside lung ultrasonography and computed tomography
scans can provide useful information for the management of patients and
detection of prognostic factors. [5]
The management of ARDS is essentially supportive; cardio respiratory
and nutritional support, the prevention of further lung injury and the
prevention of complications; while waiting for the acute inflammatory
response to resolve and lung function to improve. [6]
The aim of mechanical ventilation in ARDS is to provide oxygenation
and ventilation, while reducing the risk of ventilator-induced lung injury.
[1]
Mechanical ventilation could be harmful for the healthy as well as
injured lungs by an inappropriate setting of the ventilator, but mechanical
ventilation is still and will be a standard care for patients with ARDS even
after the introduction of Extra Corporeal Membrane Oxygenation
(ECMO)