ARF And ARDS Flashcards
Risk Factors of ARDS
- 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 Physical assessment
Findings:
* Intercostal Retractions
* Crackles on auscultation
ARDS Chest X-ray Assessment
Findings:
* Progressive pulmonary Edma
* Quickly worsening bilateral infiltrates
* Increasing alveolar dead space
ARDS Diagnostics BNP
- Brain natriuretic peptide (BNP) level- Differentiate between ARDS and cardiogenic pulmonary edema. Higher levels of BNP are associated with a decreased odds for ARDS
ARDS Diagnostic-Echocardiography
- Echocardiography- Transthoracic echocardiogram my be used if the BNP is not conclusive.
ARDS Diagnostic-Pulmonary artery catheterization
- Pulmonary artery catheterization Findings:
Absence of elevated left atrial pressure
Mild ARDS
arterial oxygen tension (PaO2)/fraction of inspired oxygen (FIO2) > 200 mm Hg but ≤300 mm Hg,
Moderate ARDS
PaO2/FIO2 > 100 mm Hg but ≤200 mm Hg,
Severe ARDS
PaO2/FIO2 ≤ 100 mm Hg
ARDS Medical Management
Identification and treatment of underlying cause
ARDS Medical Mgt Supportive Measures
Supportive measures:
* Supplemental oxygen
* Intubation
* Mechanical ventilation with PEEP
* Circulatory support
* Prone positioning- Up tp 16 hrs per day
* Sedation
* Paralysis
* Nutritional therapy
* Frequent repositioning
Acute Respiratory Failure
(Happens suddenly without warning)
A sudden and life-threatening deterioration of the gas exchange function of the lungs and indicates their failure to provide adequate oxygenation or ventilation for the blood.
ARF- Early Signs
Early
* Restlessness
* Tachycardia
* Hypertension
* Fatigue
* Headache
ARF- Late Signs
Late
* Confusion
* Lethargy
* Central cyanosis
* Diaphoresis
* Respiratory arrest
ARF- Characteristics of Hypoxia
Hypoxia- a decrease in arterial oxygen tension, PAO2 less than 60 mm HG
ARF-Characteristics of Hypercapnia
Hypercapnia- Increase in arterial carbon dioxide tension PACO2, greater than 50 mm HG
ARF- Characteristics of Respiratory Acidosis
Respiratory Acidosis- an arterial PH less than 7.35
Endotracheal Intubation – timeframe
ET intubation may be used for no longer than 14 to 21 days,
by which time a tracheostomy must be considered to decrease irritation of and trauma to the tracheal lining, to reduce the incidence of vocal cord paralysis (secondary to laryngeal nerve damage), and to decrease the work of breathing.
ABCDEF Bundle
The ABCDEF bundle consists of the following components:
A: Assess, prevent, and manage pain.
B: Both spontaneous awakening and spontaneous breathing trials.
C: Choice of analgesic and sedation.
D: Delirium assessment, prevention, and management.
E: Early mobility and exercise.
F: Family engagement and empowerment.
Delirium and Post intensive Care Syndrome (PICS)-
ABCDEF Bundle
It is believed that implementing this bundle can mitigate risks for delirium and possibly PICS. The goals of this bundle are to improve communication among members of the health care team, standardize care related to the assessment and use of sedation, provide nonpharmacologic interventions in the management of delirium, provide early exercise and ambulation, and incorporate family’s concerns and participation in care planning
COVID-19 Considerations- PEEP
PEEP > 5 cm H2O should be delivered (although the patient should be closely monitored for barotrauma if the PEEP is >10 cm H2O);
COVID-19 Considerations- Low doses of Corticosteroids
Low dosages of intravenous corticosteroids (e.g., dexamethasone, methylprednisolone) may be prescribed;
COVID-19 Considerations-Nitric Oxide
Nitric oxide should not be routinely prescribed; however, for patients with severe ARDS refractory to other treatments, nitric oxide might be tried;
COVID-19 Considerations- Prone Positioning
For the patient with moderate or severe ARDS, prone positioning for 12 to 16 hours daily is recommended, if feasible; and
