Adult Respiratory Distress Syndrome: Causes

Pathogenesis (disease development)

ARDS describes the acute respiratory failure of the previously lung-healthy individual, which is due to acute disruption of the function of the alveolar (pulmonary alveoli)-capillary (hair vessels) barrier of the lung.

Three stages can be distinguished:

Exudative, inflammatory (acute) phase – capillary permeability increased, interstitial pulmonary edema (in this case, the fluid in the lung is stored mainly in the connective tissue supporting framework of the lung and the intercellular spaces (interstitium)).
Proliferative (subacute) phase – alveolar pulmonary edema (in this case, the fluid located in the lungs is stored mainly in the alveoli) due to the demise of pneumocytes
Fibronizing (chronic) phase – irreversible pulmonary fibrosis (disease of lung tissue resulting from increased formation of connective tissue between alveoli) and endothelial proliferation (proliferation of endothelial cells/cells lining blood vessels)

Typical causes are (see below):

Direct pulmonary injury: e.g., severe pulmonary infections (pneumonia, aspiration pneumonia), inhalational noxious agents.
Indirect pulmonary injury: acute pancreatitis, sepsis, consumptive coagulopathy, burn, trauma.

Behavioral causes

Disease-related causes

Respiratory system (J00-J99)

Aspiration pneumonia (form of pneumonia resulting from aspiration/inhalation of foreign bodies or fluids) (14.2% of cases)
Pneumonia (pneumonia) (59.4% of cases).

Blood, blood-forming organs – immune system (D50-D90).

Disseminated intravascular coagulation (DIC; Disseminated Intravascular Coagulation) – acquired life-threatening condition in which clotting factors and platelets (blood clots) are depleted by excessive blood clotting in the vascular system, resulting in a bleeding tendency.

Infectious and parasitic diseases (A00-B99).

Sepsis (blood poisoning), extrapulmonary (“outside the lungs”); approximately 16% of cases), e.g., urosepsis (systemic inflammatory reaction of the entire organism resulting from a bacterial infection originating in the urinary tract)

Liver, gallbladder and bile ducts – pancreas (pancreas) (K70-K77; K80-K87).

Symptoms and abnormal clinical and laboratory findings not elsewhere classified (R00-R99)

Injuries, poisonings, and other sequelae of external causes (S00-T98).

Aspiration (inhalation into the lungs) of stomach contents, water, foreign bodies
Near drowning
Fat embolism – occlusion of vessels by penetration of fat droplets from tissues.
Inhalation trauma – lung damage caused by smoke inhalation.
Lung contusion (pulmonary contusion)
Reperfusion trauma – damage to organs that can occur after reopening of vessels after prolonged strangulation.
Craniocerebral trauma (TBI).
Burns
Injuries, unspecified, resulting in prolonged hypotension (low blood pressure)

Medications

Transfusion-associated acute respiratory insufficiency (TRALI) – acute lung disease with respiratory distress that can occur after transfusion of blood products.
Drug intoxication, unspecified
Narcotics

Operations

Environmental pollution – intoxications (poisonings).