ARDS Flashcards
is a term commonly used to describe mild ARDS
Acute lung injury
is a clinical syndrome characterized by a severe inflammatory process causing diffuse alveolar damage
ARDS
Results of ARDS
sudden and progressive pulmonary edema, increasing bilateral infiltrates on chest x-ray, hypoxemia unresponsive to oxygen supplementation regardless of the amount of PEEP, and the absence of an elevated left atrial pressure
A wide range of factors are associated with the development of ARDS including
Direct injury to the lungs (smoke inhalation)
Indirect insult (shock)
ARDS has been associated with a mortality rate ranging from
27% to 50%
Patients who survive the initial cause of ARDS may die later, commonly from
HCAP or sepsis
Risk factors
Aspiration (gastric secretions, drowning, hydrocarbons)
COVID-19 pneumonia
Drug ingestion and overdose
Fat or air embolism
Hematologic disorders (disseminated intravascular coagulation, massive transfusions, cardiopulmonary bypass)
Localized infection (bacterial, fungal, viral pneumonia)
Major surgery
Metabolic disorders (pancreatitis, uremia)
Prolonged inhalation of high concentrations of oxygen, smoke, or corrosive substances
Sepsis
Shock (any cause)
Trauma (pulmonary contusion, multiple fractures, head injury)
ARDS closely resembles
Severe pulmonary edema
The acute phase of ARDS is marked by a
rapid onset of severe dyspnea
occurs less than 72 hours after the precipitating event
ARDS is classified according to the
Severity of Hypoxemia
Clinical manifestations
severe pulmonary edema
rapid onset of severe dyspnea
Arterial hypoxemia, no response to oxygen
Chest xray similar to cardiogenic pulmonary edema
fibrosing alveolitis
increased alveolar dead space
decreased pulmonary compliance
ventilation to alveoli but poor perfusion
alveolar dead space
recovery phase
hypoxemia gradually resolves, the chest x-ray improves, and the lungs become more compliant
Assessment and dx
PA: intercostal retractions and crackles
Dx: plasma brain natriuretic peptide (BNP) levels, echocardiography, and pulmonary artery catheterization
helpful in distinguishing ARDS from cardiogenic pulmonary edema
BNP
may be used if the BNP is not conclusive
Transthoracic echocardiography
Medical mgt
Supportive Therapy
*ET intubation
*Mechanical ventilation
Circulatory support
Adequate fluid volume
Nutritional support
Supplemental oxygen
PEEP Support
Inotropic or vasopressor agents
The primary focus in the management of ARDS include
identification and treatment of the underlying condition
This supportive therapy almost always includes
ET intubation and mechanical ventilation
is used as the patient begins the initial spiral of hypoxemia
Supplemental oxygen