The pulmonary physician and critical care. 3. Pharmacotherapy in lung injury.

Abstract

The term adult respiratory distress syndrome (ARDS) was first used in 1967 to define the condition of severe parenchymal lung injury leading to refractory hypoxaemia in the absence of left ventricular failure.' In 1972 it was suggested that there are around 150 000 cases of ARDS a year in the United States alone,2 but European data are scarce and estimates of incidence vary widely. A recent retrospective study in a single region of the United Kingdom identified 2 5 cases a year per 100 000 population,3 suggesting that 1000-1500 cases of established ARDS occur in Britain each year. The associated mortality is high,4 approaching 70% in patients with sepsis complicated by ARDS and 90% when ARDS follows aspiration pneumonia.5 The cause of death depends on the underlying insult, its site and severity, the response to treatment, and the incidence ofcomplications affecting other organ systems: irreversible respiratory failure is res-ponsible for only 16% of deaths,6 and most deaths are due to multiple organ failure. The clinical features that define ARDS can in