Indian Journal of Critical Care Medicine

Register      Login



Volume / Issue

Online First

Related articles

VOLUME 20 , ISSUE 3 ( 2016 ) > List of Articles


Acute respiratory distress syndrome: Pulmonary and extrapulmonary not so similar

Keywords : Acute lung injury, acute respiratory distress syndrome, esophageal pressure, lung compliance, transpulmonary pressure

Citation Information : Acute respiratory distress syndrome: Pulmonary and extrapulmonary not so similar. Indian J Crit Care Med 2016; 20 (3):194-197.

DOI: 10.4103/0972-5229.178188

License: CC BY-ND 3.0

Published Online: 01-10-2013

Copyright Statement:  Copyright © 2016; The Author(s).


Acute respiratory distress syndrome (ARDS) is characterized by acute onset respiratory failure with bilateral pulmonary infiltrates and hypoxemia. Current evidence suggests different respiratory mechanics in pulmonary ARDS (ARDSp) and extrapulmonary ARDS (ARDSexp) with disproportionate decrease in lung compliance in the former and chest wall compliance in the latter. Herein, we report two patients of ARDS, one each with ARDSp and ARDSexp that were managed using real-time esophageal pressure monitoring using the AVEA ventilator to tailor the ventilatory strategy.

PDF Share
  1. Gattinoni L, Pelosi P, Suter PM, Pedoto A, Vercesi P, Lissoni A. Acute respiratory distress syndrome caused by pulmonary and extrapulmonary disease. Different syndromes? Am J Respir Crit Care Med 1998;158:3-11.
  2. Pugin J, Verghese G, Widmer MC, Matthay MA. The alveolar space is the site of intense inflammatory and profibrotic reactions in the early phase of acute respiratory distress syndrome. Crit Care Med 1999;27:304-12.
  3. Pelosi P, D′Onofrio D, Chiumello D, Paolo S, Chiara G, Capelozzi VL, et al. Pulmonary and extrapulmonary acute respiratory distress syndrome are different. Eur Respir J Suppl 2003;42:48s-56s.
  4. Müller-Leisse C, Klosterhalfen B, Hauptmann S, Simon HB, Kashefi A, Andreopoulos D, et al. Computed tomography and histologic results in the early stages of endotoxin-injured pig lungs as a model for adult respiratory distress syndrome. Invest Radiol 1993;28:39-45.
  5. Seidenfeld JJ, Mullins RC rd, Fowler SR, Johanson WG Jr. Bacterial infection and acute lung injury in hamsters. Am Rev Respir Dis 1986;134:22-6.
  6. Eisner MD, Thompson T, Hudson LD, Luce JM, Hayden D, Schoenfeld D, et al. Efficacy of low tidal volume ventilation in patients with different clinical risk factors for acute lung injury and the acute respiratory distress syndrome. Am J Respir Crit Care Med 2001;164:231-6.
  7. Agarwal R, Aggarwal AN, Gupta D, Behera D, Jindal SK. Etiology and outcomes of pulmonary and extrapulmonary acute lung injury/ARDS in a respiratory ICU in North India. Chest 2006;130:724-9.
  8. Agarwal R, Srinivas R, Nath A, Jindal SK. Is the mortality higher in the pulmonary vs. the extrapulmonary ARDS? A meta analysis. Chest 2008;133:1463-73.
  9. Ventilation with lower tidal volumes as compared with traditional tidal volumes for acute lung injury and the acute respiratory distress syndrome. The acute respiratory distress syndrome network. N Engl J Med 2000;342:1301-8.
  10. Talmor D, Sarge T, Malhotra A, O′Donnell CR, Ritz R, Lisbon A, et al. Mechanical ventilation guided by esophageal pressure in acute lung injury. N Engl J Med 2008;359:2095-104.
  11. Polese G, Rossi A, Appendini L, Brandi G, Bates JH, Brandolese R. Partitioning of respiratory mechanics in mechanically ventilated patients. J Appl Physiol 1991;71:2425-33.
  12. Goodman LR, Fumagalli R, Tagliabue P, Tagliabue M, Ferrario M, Gattinoni L, et al. Adult respiratory distress syndrome due to pulmonary and extrapulmonary causes: CT, clinical, and functional correlations. Radiology 1999;213:545-52.
  13. Pelosi P, Colombo G, Gamberoni C. Effects of positive end-expiratory pressure on respiratory function in head-injured patients. Intensive Care Med 2002;26:A450.
PDF Share
PDF Share

© Jaypee Brothers Medical Publishers (P) LTD.