ARDS Flashcards
What is ARDS? What are two stages?
Bilateral pulmonary infiltrates and severe hyperaemia caused by direct lung injury or secondary to severe systemic illness
Lung damage and release of inflammatory mediators cause increased alveolar capillary permeability leading to accumulation of fluid –> non-cariogenic pulmonary oedema, often accompanied by multi=organ failure.
Early stage = exudative phase of injury with associated oedema
Later stage = repair and fibroproliferative stages
What are causes of ARDS?
Infection: sepsis pneumonia Gastric aspiration Smoke inhalation Trauma Pancreatitis Multiple massive transfusions DIC Acute liver failure Obstetric events Embolism Drugs/Toxins
What are clinical features of ARDS?
Dyspnoea Cyanosis TAchycardia Tachypnoea PEripheral vasodilation Elevated RR Bilateral lung crackles Low SaO2
What investigations in ARDS?
Bedside: SaO2, BP
Bloods: FBC, U&E, LFT, Amylase, clotting, CRP, blood cultures, ABG,
Imaging: CXR - bilateral pulmonary infiltrates
Other:
What are the diagnostic criteria for ARDS?
Acute onset (within 1 week of risk factor)
Pulmonary oedema - bilateral infiltrates on chest xray
Non-cariogenic - pulmonary artery wedge pressure measured with pulmonary artery catheter
Refractory hyperaemia PaO2:FiO2 < 200
How is ARDS managed?
ITU admission
Supportive therapy
Treat underlying cause
Resp: oxygenation/venitlation CPAP/mechanical ventilation
Circulatory: arterial line, fluid mangmengement
Spesos : abx
Nutritional support
Steroids
DVT prophylaxis
What does CXR show for ARDS?
Bilateral pulmonary infiltrates - pulmonary oedema
Intersitisal oedema
Batwing appearance
Upper lobe diversion - dilated upper lobe vessels
Kerley B lines - expansion of the interstitial space by fluid
Pleural effusion possible
