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TREATMENT

■ Drainage of pleural space:Required in all cases

■ If exudative stage: Tube thoracostomy and IV antibiotics

■ Fibrinopurulent and organizational stage empyemas often require more

aggressive surgical management (eg, intrapleural fibrinolytics).

Acute Respiratory Distress Syndrome

The root problem underlying the development of ARDS is acute lung injury

(ALI), which arises for many different reasons. Not all ALI progresses to

ARDS, but all cases of ARDS begin as ALI.

CAUSES

See Table 10.14.

PATHOPHYSIOLOGY

■ Triggering event → complex inflammatory response → both alveolar

epithelial cell and vascular endothelial cell injury.

■ Cell injury →capillary leak, cell death, and loss of surfactant resulting in

diseased alveoli that do not participate in oxygenation (shunt).

■ Diseased segments of the lung are interspersed with healthy segments.

SYMPTOMS/EXAM

Presents with rapid onset of dyspnea, tachypnea, and diffuse crackles

DIFFERENTIAL

Includes cardiogenic pulmonary edema, pneumonia, diffuse alveolar hemorrhage

THORACIC AND RESPIRATORY

DISORDERS

TABLE 10.14. Causes of Acute Lung Injury and ARDS

Direct pulmonary injury

Pneumonia

Aspiration

Toxic inhalation

Ventilator associated

Indirect pulmonary injury

Infection (systemic)

Pancreatitis

Drugs (heroin, ASA)

Trauma