A 46-year-old man presents to the hospital with a 5-day history of worsening cough, high fever, and.

A 46-year-old man presents to the hospital with a 5-day
history of worsening cough, high fever, and shortness of breath. On physical
examination, he is noted to be tachypneic (respiratory rate of 30 breaths/min),
hypoxic with a low oxygen saturation (89%), and febrile (39°C). Chest x-ray
film reveals infiltrates in both lower lobes. A complete blood count reveals a
high white blood cell count. He is admitted to the hospital. Despite treatment
with oxygen and antibiotics, he becomes more hypoxic and requires endotracheal
intubation and mechanical ventilation. Blood cultures grow
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A 46-year-old man presents to the hospital with a 5-day
history of worsening cough, high fever, and shortness of breath. On physical
examination, he is noted to be tachypneic (respiratory rate of 30 breaths/min),
hypoxic with a low oxygen saturation (89%), and febrile (39°C). Chest x-ray
film reveals infiltrates in both lower lobes. A complete blood count reveals a
high white blood cell count. He is admitted to the hospital. Despite treatment
with oxygen and antibiotics, he becomes more hypoxic and requires endotracheal
intubation and mechanical ventilation. Blood cultures grow Streptococcus
pneumoniae. Despite mechanical ventilation using high oxygen concentrations,
his arterial blood oxygen level remains low. His chest x-ray film shows
progression of infiltrates throughout both lung fields. He is diagnosed with
acute respiratory distress syndrome (ARDS).

Questions

A. What are the main pathophysiologic factors in ARDS that
cause an accumulation of extravascular fluid in the lungs?

B. What are the common causes of ARDS?

C. What accounts for the severe hypoxia often found in ARDS,
despite the use of mechanical ventilation and high concentrations of oxygen?

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