Aetiology

As part of the exaggerated inflammatory response following a major exogenous insult which may be either direct (e.g. chest trauma, inhalation injury) or distant (e.g. peritonitis, major haemorrhage, burns). Histology reveals aggregation and activation of neutrophils and platelets, patchy endothelial and alveolar disruption, interstitial oedema and fibrosis. Classically, the acute phase is characterised by increased capillary permeability and the fibroproliferative phase (after 7 days) by a predominant fibrotic reaction. However, more recent data would suggest such distinctions are not so clear-cut; there may be evidence of markers of fibrosis as early as day 1.

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