Adult respiratory distress syndrome

Abstract

In this article the authors present a case of successful treatment of a 54-year old male patient with non-insulin dependent diabetes mellitus (NIDDM) and triple-vessel coronary artery disease who underwent surgical miocardial revascularization and was reoperated on the same day because of excessive bleeding. The patient was given cca 5000 mL of whole blood and cca 3000 mL of blood derivatives. The first postoperative chest X-ray showed radiological signs of ARDS. The therapy was based upon authors' experience and was consisted of controlled mechanical ventilation (respiratory volume 12-15 mL/kg, 10-14 cycles/min, I/E ratio 1:2, FIO2 0.6, PEEP 2-5 cm H20), daily bronchoscopies with bronchoaspiration, aggressive diuresis, negative fluid ballance, specific antibiotic theraphy, and last but not least, of prostaglandin E1 (PGE1) 0.5-20 μg/kg/min combined with dopamine inotropic support (2-5 μg/kg/h). Simple but careful clinical observation still remains a milestone for all therapeutic measures taken in ARDS patients.