When the pulmonary parenchyma is grossly and irreversibly damaged, hypoxemia and hypercapnia may persist despite treatment, in such cases partial relief can be obtained by giving long term continuous or intermittent oxygen therapy.
Respiratory Distress syndrome
This may occur in the newborn or the adult.
Adult respiratory distress syndrome (ARDS)
When severe respiratory distress develops fairly acutely in a previously healthy person as a result of edema in the interstitium and alveoli it is termed ARDS. This disorder is known by several names such as shock lung, wet lung, etc, since it may accompany different conditions such as shock, septicemia, inhalation of irritant gases, drug reactions, etc. The main pathological process involves damage to pulmonary capillaries and extravesation of fluid into the interestitium and alveoli. The condition is always secondary to an underlying medical or surgical condition, which is quite evident. Clinical examination shows widespread crackles and wheezes over the chest. The widespread diffuse pulmonary edema can be demonstrated radiologically. ARDS is associated with a high mortality (about 50%). Management is on the lines of acute respiratory failure. Introduction of PEEP respiration has helped in reducing mortality.
Respiratory distress syndrome of the newborn (RDS)
This is a condition seen more commonly in infants born prematurely and it is caused mainly by the absence of surfactant. The infant shows tachypnea, expiratory grunt indrawing of the intercostals spaces and cyanosis. Absence of surfactant results in atelectasis of the alveoli. Untreated, the mortality is high. With modern management the mortality has come down considerably. The risk of RDS in the newborn can be assessed antenatally by the estimation of lecithin/sphingomyelin ratio (L/S) in the amniotic fluid. Administration of corticosteroids to the mother before delivery reduces the risk of RDS in the newborn.
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