Acute Respiratory Distress Syndrome (ARDS) Notes

Question 1

Acute Respiratory Distress Syndrome (ARDS) definition

Answer 1

Sudden and progressive form of ARF

Alveolar-capillary membrane becomes damaged and more permeable to intravascular fluid.

Question 2

3 Stages of ARDS and clinical progression

Answer 2

Injury or exudative phase - 24-72 hrs after initial insult , lasts up to 7 days. PE resolves, complete recovery can occur within a week or so.
Reparative or proliferative phase - 1-2 wks after lung injury.
Fibrotic or chronic phase - 2-3 wks after initial lung injury, lung can be completely remodeled. poor prognosis with several weeks of long-term mechanical ventilation

Question 3

Factors that determine course of ARDS

Answer 3

initial injury extent
severity of course morbidities
pulmonary complications

Question 4

C/M of Early stages of ARDS:

Answer 4

initial injury until 48 hours later.
Mild dyspnea, tachypnea, cough and restlessness.
Normal to scattered crackles.
ABGs show mild hypoxemia and respiratory alkalosis.

Question 5

C/M as ARDS progresses:

Answer 5

Respiratory distress becomes evident as WOB increases.
Tachypnea, intercostal and suprasternal retractions may be present.
Tachycardia, diaphoresis, LOC changes, cyanosis, pallor
Chest x-ray: diffuse and extensive bilateral interstitial and alveolar infiltrates.
Refractory hypoxemia - classical hallmark of ARDS.

Question 6

Classic Interpretations of ARDS

Answer 6

Profound dyspnea, hypoxemia, increased WOB, and respiratory distress.
Require endotracheal intubation and PPV.
Chest x-ray: Whiteout lung, lots of infiltrates.
Severe hypoxemia, hypercapnia, metabolic acidosis and organ dysfunction are present.

Question 7

cistracarium (Nimbex)

Answer 7

Neuromuscular blocking agent (NMBA)
Relaxes skeletal muscles and promote synchrony with mechanical ventilation
Always give with concurrent analgesia and sedation to pts.
Use for shortest duration at lowest dose possible.
Monitor levels of sedation in pts.

Question 8

How do you monitor levels of sedation in pts. ?

Answer 8

Monitor clinical assessment

Respiratory rate and whether pt is taking breaths above set rate on ventilator.

Question 9

Cardiac Complications Associated with ARDS

Answer 9

Decreased CO

Dysrhythmias

Question 10

CNS and Psychologic Complications Associated with ARDS

Answer 10

Delirium

PTSD

Question 11

GI Complications Associated with ARDS

Answer 11

Hypermetabolic state, increase nutrition requirements
Paralytic ileus
Pneumoperitoneum (abnormal presence of air)
Stress ulceration and hemorrhage

Question 12

Hematologic Complications Associated with ARDS

Answer 12

Anemia
DIC
Thrombocytopenia
VTE

Question 13

Infection Complications Associated with ARDS

Answer 13

Catheter- related infection

Sepsis

Question 14

Renal Complications Associated with ARDS

Answer 14

AKI

Question 15

Respiratory Complications Associated with ARDS

Answer 15

PE
Pulmonary fibrosis
Ventilator associated: volutrauma or barotrauma
VAP

Question 16

What vital organs are affected by ARDS?

Answer 16

Lungs
Kidneys
Liver
Heart

Question 17

Main cause of death in ARDS:

Answer 17

MODS

Question 18

Long-term complications with ARDS

Answer 18

Abnormal lung function where Pt reports extreme tiredness, chest pain, SOB after minimal activity, persistent dyspnea post-ARDS.

Question 19

How to tx VAP?

Answer 19

Elevate HOB 30-45 degrees, strict infection control, and frequent oral care.

Question 20

Barotrauma definition

Answer 20

Fragile alveoli are overdistended with excess pressure during mechanical ventilation.

Question 21

What should you monitor or consider when pt develops AKI with ARDS?

Answer 21

Monitor I&O, daily creatinine and urea levels.

Allow for dialysis therapy and Continuos renal replacement therapy (CRRT).