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May 1980

Adult Respiratory Distress Syndrome and Gram-Negative Sepsis: A Deadly Duo

Arch Intern Med. 1980;140(5):612-613. doi:10.1001/archinte.1980.00330170028017

The article by Kaplan et al in the August issue of the Archives (139:867-869,1979) shows that adult respiratory distress syndrome (ARDS) not infrequently follows sepsis, as in 20 of 86 cases of Gram-negative septicemia, hypoxemia developed; ventilator support was required and other findings were consistent with ARDS. This retrospective study showed that the association of ARDS and sepsis has a dismal prognosis, with a mortality of 90%. The authors further report that 11 of the 16 patients with ARDS had thrombocytopenia, suggesting that platelets participate in the pathogenesis of ARDS. Sepsis has long been recognized as a factor in association with ARDS, but the frequency, mortality, and particularly the pathogenetic mechanisms remain unclear.

The high frequency noted by Kaplan and co-workers is confirmed by the recently completed prospective study of extracorporeal membrane oxygenation (ECMO) in the treatment of ARDS.1 In this nine-center collaborative study, 59 of the 90 patients