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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\u2010to\u2010perfusion ratios contribute to the venous admixture. The various mechanisms by which hypercarbia may develop and by which positive end\u2010expiratory 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\u2010to\u2010perfusion. \u00a9 2012 American Physiological Society.<jats:italic>Compr Physiol<\/jats:italic>2:1585\u20101617, 2012.<\/jats:p>","DOI":"10.1002\/cphy.c090019","type":"other","created":{"date-parts":[[2012,6,26]],"date-time":"2012-06-26T22:44:57Z","timestamp":1340750697000},"page":"1585-1617","source":"Crossref","is-referenced-by-count":3,"title":["Gas Exchange in the Respiratory Distress Syndromes"],"prefix":"10.1002","author":[{"given":"Richard K.","family":"Albert","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Alan","family":"Jobe","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2012,7]]},"reference":[{"key":"e_1_2_4_2_1","doi-asserted-by":"crossref","unstructured":"BernardGR ArtigasA BrighamKL CarletJ FalkeK HudsonL LamyM LegallJR MorrisA SpraggR.The American\u2010European consensus conference on ARDS. 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