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Hypoxemia in the acute respiratory distress syndrome may be due to a variety of causes: trùe pulmonary shunt, decreased ventilation/perfusion ratios, impaired diffusion and/or fall of mixed venous oxygen. In order to sort out these different tension mechanisms, 18 patients with acute respiratory distress syndrome were explored by the inert gas method. In 6 of them hypoxemia was due to a true shunt (35 +/- 10%). The remaining 12 patients also had a true shunt (26.5 +/- 9.5%), but 4.5% of the cardiac output was distributed to areas with a ventilation/perfusion ratio between 0.1 and 0.005. Thus, in these 18 patients with acute respiratory distress, hypoxemia could be explained essentially by a true shunt.
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