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Critical Care Medicine


Answer 2
  1. Unsuspected MVD. Each of the entities listed may provoke pulmonary edema in a pregnant or peripartum patient; however, the definition of ARDS requires (1) acute onset; (2) bilateral radiographic abnormalities; (3) severe hypoxemia, with Pao2/Fio2 ratio less than 200; and (4) absence of left atrial hypertension.4 ALI requires the same conditions but requires a Pao2/Fio2 ratio less than 300. MVD may be discovered for the first time during pregnancy, but it causes pulmonary edema on the basis of increased hydrostatic pressure via an increased left atrial pressure. Thus, MVD does not meet criteria for ARDS. Pneumonia, aspiration (especially with caesarean section), amniotic fluid embolism, and retained products of conception leading to diffuse intravascular coagulation have the potential to cause ALI/ARDS.

    REFERENCES
    4. Bernard GR, Artigas A, Brigham KL, et al. The American-European Consensus Conference on ARDS. Definitions, mechanisms, relevant outcomes, and clinical trial coordination. Am J Respir Crit Care Med 1994;149(3 Pt 1): 818-24.

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