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
The concentration of oxygen and ventilator settings and modes are determined by the patient’s status. This is monitored by
arterial blood gas analysis,
pulse oximetry,
bedside pulmonary function testing
is a critical part of the treatment of ARDS
Providing ventilatory PEEP support
usually improves oxygenation, but it does not influence the natural history of the syndrome.
PEEP
The use of PEEP helps
increase functional residual capacity and reverse alveolar collapse
by keeping the alveoli open
By using PEEP, a lower FiO2 may be required. The goal is a
PaO2 greater than 60 mm Hg or an oxygen saturation level of greater than 90% at the lowest possible FiO2
may occur in ARDS as a result of hypovolemia secondary to
leakage of fluid into the interstitial spaces and depressed cardiac output from high levels of PEEP therapy
Systemic hypotension may
must be carefully treated without causing further overload. Inotropic
Hypovolemia
Additional supportive treatments may include
prone positioning, sedation, paralysis, and nutritional suppo
Pharmacologic Theraphy
No specific
Neuromuscular blocking agents,
sedatives
and analgesics
may be used to improve patient–ventilator synchronization and help to decrease severe hypoxemia
Neuromuscular blocking agents, sedatives, and analgesics
Nutritional support
is vital in the treatment of ARDS
Patients with ARDS require … to meet caloric requirements
35 to 45 kcal/kg/day
is the first consideration; however, … also may be required.
Enteral feeding
parenteral nutrition
Nrsg mgt: GENERAL MEASURES
Respiratory modalities:
oxygen administration,
nebulizer therapy,
CPT
ET intubation or tracheostomy,
mechanical ventilation suctioning
bronchoscopy
Others:
Positioning
Oxygenation
Devices and specialty beds
Reduce pt anxiety
Rest
The nurse turns the patient frequently to improve ventilation and perfusion in the lungs and enhance secretion drainage
Positioning
Oxygenation in patients with ARDS is sometimes improved in the …; this seems to be particularly true for patients with COVID-19 and ARDS
prone position
are available to assist the nurse in placing the patient in a prone position
Devices and specialty beds
It increases oxygen expenditure by preventing rest.
Anxiety
is essential to limit oxygen consumption and reduce oxygen needs.
Rest
Nrsg. Mgt: VENTILATORY CONSIDERATIONS
patient-ventilator dyssynchrony
sedation
neuromuscular blocking agents (paralytic agents)
Peripheral nerve stimulators
Eye care
Analgesia with neuromuscular blocking agents
to decrease the patient’s oxygen consumption, allow the ventilator to provide full support of ventilation, and decrease the patient’s anxiety
Sedation
patient-ventilator dyssynchrony
Peep problems
PEEP, which causes…..is an unnatural pattern of breathing and feels strange to the patient
increased end-expiratory pressure
Sedatives
lorazepam, midazolam, dexmedetomidine, propofol, and shortacting barbiturates
Paralytic agents
pancuronium, vecuronium, atracurium, and rocuronium
are used to assess nerve impulse transmissions at the neuromuscular junction of select skeletal muscles when neuromuscular blocking agents are used.
Peripheral nerve stimulators
may be used to measure the level of neuromuscular blockade.
Train of four
important as well, because the patient cannot blink, increasing the risk of corneal abrasions.
Eye care
Neuromuscular blockers predispose the patient to
venous thromboembolism (VTE)
muscle atrophy
foot drop
stress ulcers that may cause hemorrhage
and skin breakdown.
must be given concurrently with neuromuscular blocking agents
Analgesia
