ARDS

Question 1

Discuss ARDS

Answer 1

An acute diffus inflammatory form of lung injury that is associated with a variety of aetiologies

Patient typically present with dypsnoea and reduction in arterial oxygen saturation after 6-72 hours following an inciting event

CXR will show bilateral patchy alveolar infiltrates with dependent atelectasis

Question 2

List common aetiologies of ARDS

Answer 2

• Sepsis
• Aspiration pneumonia
• Infectious pneumona
• Severe trauma and/or multiple fractures
• Pulmonary contusions
• Burns and smoke inhalation
• Transfusion related acute lung injury and massive transfusions
• Pancreatitis
• Inhalation injuries other than smoke (near drowning)
• Thoracic surgery
• Drugs (chemotherapeutic agents, amiodarone, radiation)

Question 3

Discuss Berlin criteria

Answer 3

ARDS can be diagnosed once cardiogenic pulmonary oedeam and alternative cause of acute hypoxemic respiratory failure and bilateral infilatrates have been exlcuded. The Berlin definition of ARDS requires taht all of the following be me for diagnosis

1) respiratory symptoms have begun wihtin one week of a known clinical insult or the patient must have new or worsening symptoms during the past week
2) biltateral opacities must be present on CXR or CT - these opacities must not be fully explained by pleural effusions lobar collapse lung collapse or pulmonary nodules
3) The patients failure must not be fully explained by caridac failure or fluid overload - an objective assessment to exclude hydrostatic pulmonary oedema is required if no risk factors for ARDS are present
4) A moderate to severe impairment of oxygenation must be present defined by the PF ration
- mild PF >200 but <300 on ventilator setting that include PEEP
-Moderate >100mmhg but <200mmhg on ventilator
Severe <100mmhg on a ventilator setting that includes PEEP

Question 4

DIscuss step wise approach to oxygenation in ARDS patients

Answer 4

Supplemental oxygen

• titrate o2 delivery devices as needed
• High flow nasal cannulae can be trailed
• Bipap for preoxygenation to intubatuon
• ETT - standard lung protective tirating peep to fio2, APRV, prone, inhaled NO
• ECMO