The interrelated syndromes of shock and the adult respiratory distress to attract the attention of both clinical and syndrome (ARDS) continue laboratory scientists. This reflects both the size of the problem and its unresponsiveness to current lines of treatment. Doubtless, a greater appreciation of the underlying pathophysiological disturbances during the past two decades has led to appropriate action and increased survival in the early stages but once established these syndromes have remained remarkably immune to a wide spectrum of therapeutic modalities. This observation stresses the importance of prevention but also indicates the need for continued research into the nature of the established syndromes and the means whereby they may be reversed. Drs Kox and Bihari are to be congratulated on bringing together within the covers of this volume many of the acknowledged European experts in these two fields of investigation. Each author has provided an up-to-date account of his current experimental and clinical research, and their com bined contributions makes fascinating reading. Undoubtedly, these are exciting times in the development of understanding of shock and ARDS. Inevitably, more questions are raised than answers provided, but the accumulated knowledge presented here adds significantly to our under standing of this complex biological jigsaw. From this corporate endeavour will come the clinically useful developments of the future and with them the ultimate hope that the term 'refractory' shock may be finally removed from our vocabulary.
Table of ContentsSection I: The Morphology and Pathogenesis of Acute Lung Injury.- 1 Fluid Flux Across the Microvascular Endothelium.- 2 The Morphology of the Adult Respiratory Distress Syndrome.- 3 Mediators in Acute Lung Injury: The Whole Body Inflammatory Response Hypothesis.- 4 Intravascular Microaggregates and Pulmonary Embolization in Shock and Surgery.- Section II: Pathophysiology of Septic Shock and the Adult Respiratory Distress Syndrome.- 5 Biochemical Changes in Patients at Risk from the Adult Respiratory Distress Syndrome: Does the Pancreas Play a Role?.- 6 Changing Haemodynamic Concepts in Human Septic Shock.- 7 Oxygen Delivery and Consumption in the Critically Ill: Their Relation to the Development of Multiple Organ Failure.- 8 Right Ventricular Performance and Positive End-Expiratory Pressure Ventilation.- Section III: Some Aspects of Ventilatory Support.- 9 The Physiological Basis of Ventilatory and Respiratory Support.- 10 The Arterial-Alveolar Nitrogen Difference for the Assessment of Ventilation-Perfusion Mismatch.- 11 High-frequency Ventilation: A Step Towards “Compliance-Independent” Ventilation.- 12 Extracorporeal Support in Acute Respiratory Failure.- Section IV: Some Aspects of Cardiovascular Support.- 13 The Role of Fluid Replacement in Acute Endotoxin Shock.- 14 Optimal Use of Vasoactive Agents in Septic Shock.- 15 Mechanical Assistance in the Treatment of Shock.- Section V: The Diagnosis and Prognosis of the Adult Respiratory Distress Syndrome.- 16 Prognosis in the Intensive Care Unit: General Principles and Application to Patients with the Adult Respiratory Distress Syndrome.- 17 Adult Respiratory Distress Syndrome: A Scoring System for the Estimation of the Gravity of Pulmonary Disease and Comparison of Patient Populations.- 18 The Clinical Presentation and Diagnosis of the Adult Respiratory Distress Syndrome.