Adult respiratory distress syndrome: A disorder in need of improved outcome

Abstract

In 1966 during the Vietnam War, one of us (R.D.B.) served in the United States Navy as a corpsman. Improved evacuation techniques of the wounded to mobile army surgical hospitals resulted in full medical evaluations and management of injuries within hours of the casualty. New stabilization methods in the field, coupled with early expeditious intervention, resulted in improved survival of the wounded. Associated with a better initial outcome, however, were other medical problems or surgical complications not previously recognized in this population of soldiers. One of these disorders was an acute unexpected respiratory condition of progres~ sive shortness of breath and cyanosis unrelieved with oxygen therapy. The roentgenographic similarities to cardiac pulmonary edema were striking. A vivid example involved an 18-year-old North Vietnamese civilian with a gunshot wound to the thigh that resulted in a fractured femur and severe blood loss. Crystalloid fluids and blood transfusions were aggressively given to restore her blood pressure. Twelve hours later she was noted to have shallow rapid breathing followed by frothy sputum production. Phlebotomy was performed and morphine was given as a chest roentgenogram revealed alveolar infiltrates consistent with cardiac