Acute respiratory insufficiency syndrome (Hebrew)

Acute respiratory insufficiency syndrome is a serious complication of the postresuscitation period in patients after major surgery and/or massive trauma, burn or blast injury. It is manifested initially by tachypnea, increased respiratory effort, progressive decrease in compliance, increased airway resistance, decreased arterial oxygen tension and increased arteriovenous shunting. Of 42 chest and multiple injury combat casualties treated, 3 patients developed 'wet lung' or the respiratory insufficiency syndrome; all 3 survived. The prevention of the acute respiratory insufficiency syndrome consists of prompt and appropriate treatment of shock and improving alveolar ventilation. Proper treatment includes strict control of fluid infusion, early assisted respiration by the volume/cycle respirator, positive end expiratory pressure respiration, meticulous respiratory care, continuous around the clock monitoring of pH, pO₂ and pCO₂ and broad spectrum antibiotics combined with specific antishock, antiburn or other special care of injuries. In more severe cases assisted cardiopulmonary bypass may be needed.