Adult Respiratory Distress Syndrome and Gram-Negative Sepsis

The article by Kaplan et al in the August issue of theArchives(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.¹In this nine-center collaborative study, 59 of the 90 patients