Treatment of adult respiratory distress syndrome with diuretics, dialysis, and positive end-expiratory pressure

Abstract

Twelve patients were treated prospectively for adult respiratory distress syndrome with diuresis and low levels (less than or equal to 20 mm Hg) of positive end-expiratory pressure. Eight patients responded to diuretics and two to dialysis by an increase in static compliance of the respiratory system, improvement in arterial oxygen tension and an increased urine output. Two patients did not respond with an improvement in these tests. Responses were transient and multiple doses were required to produce a sustained effect. Even with improvement of pulmonary function after treatment, the mortality was 67%, similar to that reported from other centers since 1975. Recently a new treatment protocol has been proposed that uses high positive end-expiratory pressure (greater than or equal to 20 mm Hg) early in the course of adult repiratory distress syndrome; mortality using this technique was 20%. The difference in survival may be more apparent than real since each center has a unique population of patients and time of initial therapeutic intervention. A randomized collaborative study comparing treatment protocols is needed.