Adult respiratory distress syndrome. A need for comparative studies

Acute respiratory failure that results from diffuse injury to the alveolar capillary membranes is called the adult respiratory distress syndrome (ARDS). Accepted treatment of severe ARDS includes the use of mechanical ventilation and increasing positive end-expiratory pressure (PEEP) until oxygenation can be maintained by an inspired oxygen concentration of 50%. Diuretics are usually given with monitoring of cardiopulmonary physiology for evidence of depletion of intravascular volume from the combination of diuretics and PEEP. Fluids are administered as needed to support cardiac output. Mortality has exceeded 50% in most studies despite therapy. Also, data recently reported from nine centers participating in the Extracorporeal Membrane Oxygenator (ECMO) study revealed a mortality exceeding 75% in 600 patients receiving mechanical ventilation with inspired oxygen concentration greater than 50%.1The ECMO study was most productive because it thwarted the temptation to establish such expensive therapy in every center. Recently, a new method for managing