Critical Care Obstetrics part 36 provides expert clinical guidance throughout on how you can maximize the chances of your patient and her baby surviving trauma. In this stimulating text, internationally recognized experts guide you through the most challenging situations you as an obstetrician are likely to face, enabling you to skillfully:Recognize conditions early-on which might prove life threatening, Implement immediate life-saving treatments in emergency situations, Maximize the survival prospects of both the mother and her fetus | Acute Lung Injury and Acute Respiratory Distress Syndrome ARDS During Pregnancy Table Diagnostic criteria for acute lung injury ALI and adult respiratory distress syndrome ARDS . Acute onset of respiratory distress Bilateral pulmonary infiltrates on chest X-ray PAOP 18mmHg or absence of clinical evidence of left atrial hypertension PaO2 FiO2 ratio of 200 for ARDS or 300 for ALI regardless of PEEP PAOP pulmonary artery occlusion wedge pressure PEEP positive end-expiratory pressure. tachypnea and tachycardia and physical examination signs of pulmonary edema bilateral crackles and or wheezes on chest auscultation without signs of left-sided heart failure . absent S3 elevated jugular venous pressure and peripheral edema . Chest radiography will show diffuse bilateral alveolar and or interstitial infiltrates typically without cardiomegaly. Although plain chest radiographs in ALI ARDS suggest a diffuse process studies utilizing computed tomography of the chest CT scans have shown that in fact lung involvement in ALI and ARDS is inhomogeneous with alveolar infiltrates consolidation and atelectasis that are worst in the dependent lung zones while other areas of the lung may appear to be spared 8 9 . Figure shows examples of typical findings on plain chest radiography and CT scan of the chest in ARDS. It should be noted that studies of bronchoalveolar lavage fluid from patients with ARDS have shown that even areas of the lung that appear relatively clear on radiographic examinations may have signs of significant inflammation 10 . A detailed review of the pathogenesis of ALI and ARDS has been published recently by Ware and Matthay 9 . ALI and ARDS are characterized by three distinct stages although not all patients will progress through all stages. The initial stage is an acute exudative phase which again presents clinically as acute onset of respiratory distress and hypoxemia refractory to supplemental oxygen most often resulting in respiratory failure .
