دانلود کتاب 50 مقاله شاخصی که هر متخصص باید بداند

Acute respiratory distress syndrome (ARDS) is a disease of modern technology. Without oxygen supplementation and mechanical ventilation as well as modern diagnostic technology, patients with incipient respiratory failure cannot survive long enough to show more than the initial features of ARDS let alone have the diagnosis made. It is not an accident that Ashbaugh and Petty described the syndrome during the 1960s as ICUs and blood gas machines were becoming available, and they also launching their academic careers.
ARDS clearly antedated its description. Mendelsohn’s syndrome was an example, described during the late 1940s in women who developed often lethal severe hypoxic respiratory failure after gastric aspiration that occurred as they were being intubated during labor, a common practice at that time. The reports of Da Nang Lung on mas¬sive trauma victims during the Vietnam War was another.
The dozen patients described by Ashbaugh and Petty in their Lancet 1967 report exemplified the typical findings of the syndrome: acute onset of severe dyspnea, cyanosis, and bilateral patchy infiltrates on chest x-ray. Patients responded poorly to oxygen supplementation unless given positive end-expiratory pressure (PEEP), and lung compliance was low. Pathology revealed diffuse alveolar damage and hyaline membranes. Some patients seemed to respond to corticosteroids, but mortality was still very high at 75%.
In the years since the syndrome was described, the epidemiology of ARDS has been very controversial with estimates of incidence varying from 3.5/100,000/yr on one of the Canary Islands to 58.7/100,000/yr for the Seattle area. On average, the incidence in the US has been much higher than in Europe, sometimes by an order of magnitude. Possible reasons for these disparities are manifold but include the use of different defi¬nitions that have been evolving over time: under and over-reporting, different popula¬tions with different risk factors, and health practices in different regions, hospitals, and even ICUs within the same hospital. Some of the more notable studies include the one done near Seattle, which came up with an incidence of 58.7/100,000/yr and used care¬ful screening and quality control to avoid missing patients. The COVID-19 pandemic will undoubtedly affect the incidence of ARDS for the years 2020 and 2021, but it is too early for the cases to have been counted yet.