Standard Article

Gas Exchange in the Respiratory Distress Syndromes

  1. Richard K. Albert1,
  2. Alan Jobe2

Published Online: 1 JUL 2012

DOI: 10.1002/cphy.c090019

Comprehensive Physiology

Comprehensive Physiology

How to Cite

Albert, R. K. and Jobe, A. 2012. Gas Exchange in the Respiratory Distress Syndromes. Comprehensive Physiology. 2:1585–1617.

Author Information

  1. 1

    Chief of Medicine, Denver Health, Professor of Medicine, University of Colorado, Adjunct Professor of Engineering and Computer Science, University of Denver, Denver, Colorado

  2. 2

    Professor of Pediatrics, Neonatology/Pulmonary Biology, Cincinnati Children's Hospital, University of Cincinnati, Cincinnati, Ohio

Publication History

  1. Published Online: 1 JUL 2012


This article describes the gas exchange abnormalities occurring in the acute respiratory distress syndrome seen in adults and children and in the respiratory distress syndrome that occurs in neonates. Evidence is presented indicating that the major gas exchange abnormality accounting for the hypoxemia in both conditions is shunt, and that approximately 50% of patients also have lungs regions in which low ventilation-to-perfusion ratios contribute to the venous admixture. The various mechanisms by which hypercarbia may develop and by which positive end-expiratory pressure improves gas exchange are reviewed, as are the effects of vascular tone and airway narrowing. The mechanisms by which surfactant abnormalities occur in the two conditions are described, as are the histological findings that have been associated with shunt and low ventilation-to-perfusion. © 2012 American Physiological Society. Compr Physiol 2:1585-1617, 2012.