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Analytic Reviews : Hemodynamic Management of the Adult Respiratory Distress Syndrome

Departments of Medicine and Anesthesia and the Cardiovascular Research Institute, University of California, San Francisco, Departments of Medicine and Anesthesia, Yale University School of Medicine, New Haven, CT

Yves Berthiaume, MD

Departments of Medicine and Anesthesia and the Cardiovascular Research Institute, University of California, San Francisco, Departments of Medicine and Anesthesia, Yale University School of Medicine, New Haven, CT,

James W. Biondi, MD

Departments of Medicine and Anesthesia and the Cardiovascular Research Institute, University of California, San Francisco, Departments of Medicine and Anesthesia, Yale University School of Medicine, New Haven, CT,

Michael A. Matthay, MD

University of California, San Francisco, San Francisco, CA 94143., Departments of Medicine and Anesthesia, Yale University School of Medicine, New Haven, CT

Hemodynamic management is an essential aspect of the care of patients with adult respiratory distress syn drome (ARDS). On the basis of current knowledge, our proposed goals of management are to maximize pe ripheral oxygen delivery while attempting to minimize further lung damage or dysfunction. The major patho physiologic abnormalities of ARDS are an increased lung vascular permeability, right-to-left intrapulmonary shunting, and pulmonary vascular resistance. These abnormalities must be understood to select the proper therapy. Although all patients with ARDS share these abnormalities, they differ in their associated clinical conditions and underlying cardiovascular status. Be cause each ARDS patient may respond differently to therapy, hemodynamic management must be selected empirically with the goal of therapy as a guide. We have considered available therapeutic options including posi tive end-expiratory pressure, volume depletion, volume expansion, vasopressors, and vasodilators. In the future hemodynamic management of patients with ARDS will likely change as better methods of patient assessment and treatment are developed.

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