Preservation of Normal Lung Regions in the Adult Respiratory Distress Syndrome

TLDR

Let's extract content. Summarize: Among 13 ARDS patients, 3 had generalized involvement on both imaging, 8 had apparent generalized involvement on X-ray but CT revealed patchy infiltrates with normal lung areas, and 2 had patchy involvement on both; these findings show that ARDS spares some lung regions, informing gas exchange, PEEP responsiveness, and oxygen toxicity. Other: "<i>JAMA</i>1986;255:2463-2465" – that's a citation. No extra sentences. Let's craft sentences: Background: "Regional inhomogeneity in ARDS must be considered when interpreting lung biopsy or bronchoalveolar lavage specimens." (fits) Purpose: "This report challenges the assumption that ARDS is a homogeneous process with uniform alveolar-capillary damage." (fits) Mechanism: "The study examined 13 ARDS patients, comparing chest X‑ray and CT findings of pulmonary parenchyma." (fits) Findings: "Among the 13 patients, 3 showed generalized involvement on both imaging modalities, 8 had apparent generalized involvement on X‑ray but CT revealed patchy infiltrates with normal lung areas, and 2 displayed patchy involvement on both; these results demonstrate that ARDS spares some lung regions, influencing gas exchange, PEEP responsiveness, and oxygen toxicity." (fits) Other: "JAMA 1986;255:2463-2465." (fits) Check sentence count: 5.

Abstract

In this report, we challenge the commonly held assumption that the adult respiratory distress syndrome (ARDS) is a homogeneous process associated with generalized and relatively uniform damage to the alveolar capillary membrane. We studied 13 patients with ARDS, comparing the pulmonary parenchymal changes seen by standard bedside chest roentgenograms with those seen by computed tomography of the chest. Three patients demonstrated generalized lung involvement by both radiologic techniques. In another eight patients, despite the appearance of generalized involvement on the standard chest x-ray film, the computed tomographic scans showed patchy infiltrates interspersed with areas of normal-appearing lung. Two patients showed patchy involvement by both techniques. The fact that ARDS spares some regions of lung parenchyma is useful knowledge in understanding the gas-exchange abnormalities of ARDS, the variable responsiveness to positive end-expiratory pressure, and the occurrence of oxygen toxicity. The problem of regional inhomogeneity should also be kept in mind when interpreting lung biopsy specimens or bronchoalveolar lavage fluid in patients with ARDS. (<i>JAMA</i>1986;255:2463-2465)