Acute respiratory distress

Question 1

What is ARDS?

Answer 1

Caused by increased permeability of alveolar capillaries leading to fluid accumulation in the alveoli- non- cardiogenic pulmonary oedema

Question 2

What is the prognosis for ARDS?

Answer 2

Mortality of around 40% and significant morbidity for those who survive it?

Question 3

Causes of ARDS?

Answer 3

Infection: sepsis, pneumonia
Massive blood transfusion
Trauma
Smoke inhalation
Acute pancreatitis
Cardio-pulmonary bypass

Question 4

Clinical features of ARDS?

Answer 4

Acute onset and severe:
Dyspnoea
Elevated RR
Bilateral lung crackles
Low oxygen sats

Question 5

Investigations in ARDs?

Answer 5

Cxr
ABG

Question 6

What are the criteria for ARDS?

Answer 6

American-European Consensus Conference:
Acute onset (within 1 week of a known risk factor)
Pulmonary oedema: bilateral infiltrates on chest x-ray (‘not fully explained by effusions, lobar/lung collapse or nodules)
Non-cardiogenic (pulmonary artery wedge pressure needed if doubt)
pO2/FiO2 < 40kPa (200 mmHg)

Question 7

Management of ARDS?

Answer 7

ITU
Oxygenation and ventilation to treat hypoxaemia
General organ support
Treatment of underlying cause
Prone position and muscle relaxation–> shown to improve outcomes in ARDS