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ARDS is characterized clinically by dyspnea, tachypnea, tachycardia, cyanosis, and hypoxemia. PaO2/FIO2 remains low (below 2 cc) even with oxygen therapy at high oxygen concentrations. The lung compliance is decreased so that the lung is stiffer and more difficult to ventilate. Chest radiographs show signs of bilateral interstitial and alveolar edema. Cardiac filling pressures are normal, and the pulmonary capillary wedge pressure is below 18 torr.
Most authorities consider that the syndrome has three phases or stages that characterize its progression: the exudative stage, the fibroproliferative or proliferative stage, and the resolution or recovery stage. The exudative stage comes first, two to four days after onset of lung injury, and is distinguished by the accumulation of excessive fluid in the alveoli with entrance of protein and inflammatory cells from the alveolar capillaries into the air spaces. The fibroproliferative stage comes second and is characterized by an increase in connective tissue and other structural elements in the lungs in response to the initial injury. It begins between the first and third weeks after the initial injury and may last up to ten weeks. Microscopic examination reveals lung tissue that appears densely cellular. The patient is at risk for pneumonia, sepsis, and pneumothorax at this time. The third stage is the resolution or recovery stage. During this stage the lung reorganizes and recovers, although it continues to show signs of fibrosis. Lung function may continue to improve for as long as six to twelve months or even longer, depending on the precipitating condition and severity of the injury. It is important to remember that there are often different levels of pulmonary recovery in patients with ARDS.
Some authorities refer to a fourth phase or stage of ARDS, the period after the resolution or recovery stage. Some patients continue to experience health problems caused by the acute illness, such as coughing, limited exercise tolerance, and fatigue. Anxiety, depression, and flashback memories of the critical illness may also occur and be similar to posttraumatic stress disorder.
a·cute(ă-kyūt'), Avoid the jargonistic use of this word to refer to short-term therapy, as in acute sedation.
AcuteReferring to a condition of rapid onset which is often accompanied by severe symptoms and is of generally brief duration.
(1) Analysis of Coronary Ultrasound Thrombolysis Endpoints in Acute Myocardial Infarction. A trial that studied the feasibility of ultrasound thrombolysis (UT) in patients with coronary artery occlusion.
MACE at 6 months; 39 patients.
1 death, 1 re-infarction at a new lesion; the left ventricular ejection fraction at follow-up increased by 29%, from 45 to 74%; primary coronary UT in high clot-burden lesions induces re-perfusion and highly significant myocardial salvage.
(2) Assessment of Cardioversion Utilizing Transesophageal Echocardiography. A trial comparing the feasibility and safety of TEE-guided early cardioversion to conventional cardioversion in atrial fibrillation.
Mortality slightly higher with TEE, but more patients restored to sinus rhythm with TEE; neither statistically significant.
acuteadjective Of abrupt onset, or short duration, usually of hrs or days in duration, used in reference to a disease or symptoms. Cf Chronic, Subacute.
acuteShort, sharp and quickly over. Acute conditions usually start abruptly, last for a few days and then either settle or become persistent and long-lasting (CHRONIC). From the Latin acutus , sharp.
- (of plant structures such as leaves) sharply pointed.
- (of a disease) coming quickly to a crisis.
- (of a radiation dose) applied at a high level in a short space of time. Compare CHRONIC.
Patient discussion about acute
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