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Type I pneumocytes
13%
29/225
Type II pneumocytes
25%
56/225
Chest X-ray
6%
14/225
Alveolar-arterial gradient
16%
35/225
Left atrial pressure
39%
87/225
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This patient is suffering from acute respiratory distress syndrome (ARDS). One of the main criteria for ARDS is the absence of cardiogenic pulmonary edema, and hence the left atrial pressure would be normal. ARDS is a classic cause of non-cardiogenic pulmonary edema. The left atrial pressure (usually estimated using the pulmonary capillary wedge pressure) would most likely be normal, a finding used to distinguish ARDS from other causes of pulmonary edema. A chest x-ray of an ARDS patient initially shows bilateral infiltrates, progressing to widespread alveolar consolidation with air bronchograms. Neutrophils damage both type I and type II pneumocytes in ARDS. Mortelliti et al. discuss how ARDS is characterized by the acute onset of diffuse, bilateral pulmonary infiltrates secondary to noncardiogenic pulmonary edema, refractory hypoxia, and decreased lung compliance. Sepsis, aspiration of gastric contents, trauma, or multiple transfusions are very common causes of ARDS. Donahoe reviews ARDS. Since ARDS links multiple diverse etiologies into a single common pathway, specific treatments have shown variable effectiveness. There have been many attempts at controlling the lung inflammatory response of ARDS, and the only proven therapy to consistently reduce mortality is a protective ventilation strategy. The vascular changes of ARDS can lead to a ventilation/perfusion mismatch contributing to an increase in physiologic dead space. Correction of hypoxemia and hypercapnia are integral components in the management of ARDS. Illustration A depicts an overview of the pathophysiology of ARDS. Illustration B depicts the diffuse bilateral infiltrates initially seen in ARDS. Incorrect Answers: Answer 1: Neutrophils damage type I pneumocytes in the acute inflammatory process. Answer 2: Neutrophils damage type II pneumocytes in the acute inflammatory process. Answer 3: A chest x-ray will show bilateral infiltrates, progressing to widespread alveolar consolidation in ARDS. Answer 4: The A-a gradient is elevated in ARDS due to a V/Q mismatch.
3.8
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