Complication of Fluid Therapy Causing the Acute Respiratory Distress Syndrome: Facts and Comments. The Role of Volumetric Overload Shocks in Pathoetiology

Objective: To report multiple facts and comments on the acute respiratory distress syndrome (ARDS) as well as errors and misconceptions and the role of volumetric overload shocks (VOS) in its patho-etiology.

Material and methods: Two reports in the Lancets that represent the received views on ARDS are critically analyzed to demonstrate the overlooked facts and errors and misconceptions. Data from my own research demonstrates the role of VOS in the patho-etiology of ARDS.

Results: Multiple overlooked facts on ARDS and appropriate comments on it as well as errors and misconceptions on fluid therapy are reported. The role of VOS in the patho-etiology of ARDS is summarized. Underlying the reported missing facts and errors are the erroneous Starling law on the capillary-interstitial fluid transfer. The correct replacement for Starling’s law is the hydrodynamic phenomenon of the porous orifice (G) tube.

Conclusions: ARDS is an iatrogenic complication of fluid therapy. Many overlooked facts and multiple errors and misconceptions underlie the current understanding of ARDS, Underlying all of it is the wrong physiological law of Starling on capillary interstitial fluid transfer. The correct replacement of Starling’s law is the hydrodynamic phenomenon of the porous orifice (G) tube. The real patho-etiology of ARDS is VOS.

Keywords: Hyponatraemia, Shock, ARDS, TURP syndrome, The multiple vital organ dysfunction syndrome, Fluid therapy.