Akut Respiratuvar Distress Sendromu

Akut Respiratuvar Distress Sendromu ARDS ilk kez 1967 yılında tanımlandığı günden bu güne tanımı, patogenezi ve patofizyolojisi üzerine çok sayıda araştıma yapılmış, hayatı tehtid eden ciddi mortalite ve morbiditesi bulunan bir durumdur. 1994 yılında yapılan Avrupa ve Amerika Uzlaşı konferansı sonucunda AECC- 1994 ARDS‟nin günümüzdeki tanımı yapılmıştır. Bu en son tanıma göre akut akciğer hasarı ALI akut başlayan, akciğer grafisinde bilateral infiltrasyona sebep olan, pulmoner arter oklüzyon basıncının 18mmHg‟den küçük olduğu PCWP ≤ 18mm Hg ve sol atriyum hipertansiyonu ile ilişkili olmayan, PaO2/FiO2 oranı ≤ 300 olduğu durumları kapsarken, ARDS PaO2/ FiO2 oranı ≤ 200 olan durumları içermektedir. ARDS‟nin tanımı, oluşum patofizyolojisi, epidemiyolojisi, mortalitesi ve morbiditesi üzerine bir çok araştırma devam ederken günümüze kadar elde edilen bulgular birbiri ile çelişen ve tartışmaya açık sonuçları ile dikkatli bir okuma yapılmasını gerekli kılmaktadır. Bu amaçla ele alınan bu derlemede ARDS ve patofizyolojisi ile ilgili önerilmiş modellemeler ve mekanizmalar özetlenmiştir. Akciğer koruyucu ventilasyon teknikleri, ekstra korporeal membran oksijenizasyonu, güncel medikal tedaviler, gen ve kök hücre tedavileri ve güncel literatür bilgisinin ışığında mevcut araştırmalarla ortaya çıkan yeni potansiyel tedavi yöntemleri vurgulanmıştır.

Anahtar Kelimeler:

ARDS, ALI

Acute Respiratory Distress Syndrome

Acute Respiratory Distress Syndrome ARDS is a life threatening disease with high mortality and morbidity and there has been many studies on its pathogenesis and pathophysiology since it was first described in 1967. ARDS had its current definition as a result of American-European Consensus Meeting in 1994 AECC-1994 . According to this latest definition acute lung injury ALI is described with PaO2/FiO2 ratio less than 300 mmHg, acute onset, bilateral radiographic opacities without evidence of left atrial hypertension and pulmonary occlusion pressure less than 18mmHg PCWP ≤ 18mm Hg . PaO2/FiO2 ratio less than 200 mmHg is named as ARDS. There are still numerous ongoing studies about its physiopathology, epidemiology, mortality, morbidity and controversial results of these studies require elaborative reading. The aim of this review is to summarize suggested ARDS models and mechanisms of its pathophysiology. Lung protective ventilatio techniques, extracorporeal membrane oxygenation, current medical treatments, genetic and stem cell studies and potential new treatments rising from recent studies are presented with knowledge from recent literatures.

Keywords:

ARDS, ALI,

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