PERSPECTIVES IN THE TREATMENT OF ACUTE RESPIRATORY-DISTRESS SYNDROME (ARDS)

Acute Respiratory Distress Syndrome (ARDS) comprises non-uniform events of acute respiratory failure with complex pathophysiology, including changes in pulmonary vasomotion, alterations of the alveolar surfactant systems and disturbances of endothelial permeability. Acute, elective interferences with pulmonary hemodynamic and perfusion-ventilation-distribution in ARDS decrease pulmonary hypertension and improve gas exchange. High dosage transbronchial surfactant application in early stage ARDS can partially reduce the surfactant inhibition, induced by the extravasation of plasma proteins. Surfactant application is accompanied by an improvement of oxygenation, which is caused by a recruitment of atelectatic regions. The regulation of endothelial permeability can conceptually be influenced at the level of second messenger, which is closely linked with edema formation. There are first clinical experiences of influencing the pulmonary vasomotion and the alveolar surfactant system and studies are in preparation to influence the endothelial permeability. Altogether, are these intentions new therapeutical perspectives for the managment of ARDS.