ARDS -Goya Flashcards
What are the stages of ARDS?
Exudative Stage: (0-6 days)
- Initial stage characterized by diffuse alveolar damage (fluid into alveolar space b/c injury)
- can get shunt
- CXR : normal initially –> diffuse bilateral infiltrates “white out”
- cytokines worsen
Fibroproliferative Stage: (days 7-10)
- resolution of pulmonary edema
- proliferation of type 2 alveolar cells
- hypoxemic
- fibrosing alveolitis –> dec compliance of the lung
- NOT every pt will develop this
Recovery Stage: (> 10-14 days)
- Resolution of inflammation and improved oxygenation with varying degrees of fibrosis
- CXR improve and PFTs improve
What is the treatment for ARDS?
supportive care and treat the underlying cause
mechanical ventilation (small tidal volumes)
**What tidal volume should be used for mechanical ventilation in ARDS?
low tidal volume (6-7 ml/kg)
low plateau pressures (< 30) and permissive hypercapnia and acidosis
What can PEEP help reduce?
intrapulmonary shunting and improve arterial oxygenation
What other things should be done to improve outcome in ARDS?
fluid conservation (not too much)
early glucocorticoids
prone position
PEEP
try to treat underlying disease
low tidal volume ventilation
–> try to give the lungs time to recover
What is ARDS?
ARDS is a clinical syndrome characterized by severe, acute lung injury, inflammation and scarring
most of the time is a shunt physiology
