ARDS

Question 1

What is ARDS

Answer 1

Within 1 week of insult with worsening respiratory symptoms
New bilateral opacities not explained
Hypoxia not explained by CCF or overload

Question 2

Phases of ARDS

Answer 2

1. Acute exudative phase = hypoxia, CXR changes
2. Fibrosing alveolitis = days to weeks after –> persistent poor function, bullae, fibrosis with inflammation
3. Recovery phase

Question 3

Causes of ARDS

Answer 3

Direct insult to lung = pneumonia, aspiration, confusion, fat emboli, near drowning, inhalation

Indirect = sepsis, severe trauma, pancreatitis, drug overdose, transfusion, TRALI

Question 4

Pathophysiology of ARDS

Answer 4

Inflammation –> neutrophils and cytokine and chemokine production

Endothelial and epithelial injury –> increased permeability and alveolar oedema

Organism translocation

Fibrosing alveolitis if abnormal healing

Question 5

Resolution of ARDS

Answer 5

Removal of fluid
Removal of protein
Re-epithelialisation of alveoli
Removal of inflammatory cells

Question 6

Treatment of ARDS

Answer 6

Supportive

Remove causes if present
Prevent infections and treat if present
Nutrition
VTE prophylaxis

Prone ventilation
ECMO

Question 7

Long term effects of ARDs

Answer 7

Reduced DLCO
Airflow obstruction
Restriction

Reduced QOL