الفهرس 
Introduction
Acute respiratory distress syndrome Definition, pathophysiology, etiologies and treatmentOnly 14 pages are availabe for public view
 |  | from | 116 |  |  |
| | | from | 116 | | |
Abstract
The current study was performed at Critical Care Unit of Internal Medicine Department of Assiut University Hospitals, Shrief Mokhatar critical care unit of Cairo University and ICU OF Chest Department of Assiut University during the period from February 2018 to June 2019. The work aimed to: To evaluate the ability of chest sonography in the identification of characteristic pleuro-pulmonary signs useful in the differentiation between acute cardiogenic pulmonary edema (CPE) and acute lung injury/acute respiratory distress syndrome (ALI/ARDS). This study includes two groups of patients: Sixty patients admitted into different ICUs with pulmonary edema. group A: Included 35, who had criteria met with ARDS criteria. group B: Included 25, had criteria met with CPE criteria. The study was cross sectional comparative study. The studied patients were subjected to the following: Detailed history taking include: age, sex and other comorbidities as (DM, hypertension, COPD, CKD, malignant disease) Thorough clinical examination with special attention to (blood pressure, heart rate, JVP, LL edema, temperature and respiratory rate), chest examination and cardiac examination special attention to auscultationLaboratory investigation including: CBC, Kidney function tests (serum creatinine, serum urea) and serum electrolyte (serum sodium and potassium), arterial blood gases, LFTS and cardiac enzyme. Detailed chest sonar with searching for pleuro-pulmonary signs. Transthoracic echocardiography with DopplerThe results of this study showed that: Concerning demographic data, both groups were comparable age and sex , the mean age of patients with ARDS was 48.90 ± 11.23 years and 22 (63%) of them were males while mean age of patients with CPE was 49.10 ± 10.10 years and 17 (68%) of them were males. The most frequent comorbidities in patients with ARDS were: diabetes mellitus (63%), lung disease ”COPD, Asthma with super-added infection” (42.8%) followed by hypertension (31.5%) and cardiac disease (20%). Renal and malignant diseases (e.g. metastic malignancy, lymphoma) presented in 4 (11.4%) and 3 (8.6%) patients, respectively. It was noticed that hypertension, DM and cardiac diseases, and lung diseases ” infection mainly ” presented in 17 (68%), 10 (40%), 10 (40%) and 3 (12%) patients with CPE, respectively. The most common etiologies of ARDS in our study were: pneumonia (42.8%) followed by sepsis (22.9%) and pancreatitis (20%). Aspiration and fat embolism were found in 3 (8.6%) and 2 (5.7%), respectively. On the other hand, the most common etiologies of CPE were systolic dysfunction (42%) followed by diastolic dysfunction (20%) and valvular heart disease (16%). Hypertensive pulmonary edema and arrhythmias were found in 2 (8%)and 1(4%)patients, respectively. Regarding clinical data of enrolled patients, there were no statistically significant difference between two studied groups except nearly all patients with CPE had raised JVP but only three (8.6%) patients with ARDS had raised JVP. Patients with ARDS had higher frequency of crepitation and wheezes in comparison to those with CPE. Patients with CPE and those with ARDS had insignificant differences as regarding baseline atrial blood gases. Regarding laboratory data of studied groups, there were insignificant differences between both groups with exception of; Patients with ARDS had significantly higher leucocytes, blood urea nitrogen, alanine transaminase, aspartate transaminase and C-reactive protein in comparison to CPE group. Concerning echocardiographic findings of studied groups, the frequency of left ventricular dysfunction was significantly higher among patients with CPE in comparison to those with ARDS (20 (80%) vs. 4 (11.42%); P <0.001) while both groups had insignificant differences as regarding right ventricular dysfunction and valvular heart disease based on echocardiographic findings Based on chest ultrasound alveolar interstitial syndrome (AIS), pleural line, absence of lung sliding, and spared area in all patients with ARDS while consolidation, pleural effusion, and lung pulse presented in 29 (83.3%), 21 (60%), and 18 (51.4%) patients with ARDS, respectively. It was noticed that AIS, consolidation and pleural effusion presented in 25 (100%), 1 (4%) and 23 (29%) patients with CPE, respectively. Finally, regarding outcome of the patients of our study, majority (82.9%) of patients with ARDS required mechanical ventilation and continuous positive airway pressure (CAPA) was required in six patients with ARDS. On the other hand, Majority (68%) of patients with CPE required CPAP while 5 (20%) and 3 (12%) patients required mechanical ventilation and simple mask, respectively. Most of ARDS patients died in contrast with patients of CPE.