Clinical Physiology of Circulation

Chief Editor

Leo A. Bockeria, MD, PhD, DSc, Professor, Academician of Russian Academy of Sciences, Director of Bakoulev National Medical Research Center for Cardiovascular Surgery

Этиология, патогенез и новое направление в лечении острого респираторного дистресс-синдрома

Link: Clinical Physiology of Blood Circulaiton. 2005; (): -

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Abstract

Modern anesthetic and surgical techniques allow cardiac surgery to be carried out in high-risk patients. The acute respiratory distress syndrome (ARDS) following cardiac surgery and cardiopulmonary bypass (CPB) is a rare complication (in < 2% of cases) that carries a mortality rate of 40 to 70%. An improved understanding of the pathogenesis of ARDS has led to the assessment of novel treatment strategies. The inflammatory response in ARDS is associated with recruitment of large numbers of neutrophils and monocytes to the distal airspaces of the lung and the release of proinflammatory molecules, including cytokines, oxygen radicals, and proteases. The abnormality reflects diffuse alveolar damage, involving both the endothelial and epithelial layers. This damage is characterized pathophysiologically by a breakdown in the barrier and gas exchange functions in the lung. If the process is sustained, fibroproliferation occurs with collagen deposition and lung remodeling. Both inflammation and coagulation are characteristic events during ARDS and therapeutic benefits might be expected from the modulation of either or both phenomena. Results of our study suggest that inhaled heparin and dexamethasone, because of its anticoagulant and/or anti-inflammatory properties, improves gas exchange in patient with ARDS. Moreover, combination therapy with these two agents is more beneficial than monotherapy

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