Scribd
Upload
127 views

ARDS Lecture Notes - Student

Acute respiratory distress syndrome (ARDS) is an acute lung injury characterized by bilateral pulmonary edema and decreased lung compliance. It results from various direct and indirect lung insults and is associated with high mortality. ARDS affects lung mechanics, gas exchange, and the pulmonary vasculature. Treatment involves supportive care, treating the underlying cause, and mechanical ventilation with low tidal volumes and optimal positive end-expiratory pressure to improve oxygenation while avoiding lung injury.

Uploaded by

Mary Marsh
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as DOCX, PDF, TXT or read online on Scribd
127 views

ARDS Lecture Notes - Student

Acute respiratory distress syndrome (ARDS) is an acute lung injury characterized by bilateral pulmonary edema and decreased lung compliance. It results from various direct and indirect lung insults and is associated with high mortality. ARDS affects lung mechanics, gas exchange, and the pulmonary vasculature. Treatment involves supportive care, treating the underlying cause, and mechanical ventilation with low tidal volumes and optimal positive end-expiratory pressure to improve oxygenation while avoiding lung injury.

Uploaded by

Mary Marsh
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as DOCX, PDF, TXT or read online on Scribd
You are on page 1/ 4

ARDS Lecture Notes

Student Copy
An illness or injury acutely affecting lung compliance, including a variety of contributing factors.

“Shock lung” “adult respiratory syndrome”

Acute lung injury

 Persistent lung inflammation


 Bilateral pulmonary edema

Results in:

 Decreased surfactant
 Atelectasis, with
 No evidence of left heart failure
 The intra-alveolar walls become lined with “hyaline membrane”
 Appearance is red, beefy or liver like

Acute Respiratory Distress Syndrome (ARDS)

 P/F ratio

 10%–15% of ICU patients meet ARDS criteria


 Often accompanied by multiple organ system failure
 Mortality

Etiology

Specific Causes Include:


Sepsis and shock
Severe trauma
Multiple transfusions
Aspiration
Severe pneumonia
Smoke inhalation
Drug overdose
Fluid overload
+60 other medical conditions

Pathophysiology

ARDS affects

 Lung mechanics
 Gas exchange
 Pulmonary vasculature
Pathophysiology: Results in:

Intravascular fluid leakage


↓
Alveolar flooding – surfactant dilution
↓
Microatelectasis
↓
V/Q Mismatching
↓
Refractory Hypoxemia
↓
Pulmonary Hypertension

Clinical Features

History

According to underlying cause and severity of lung damage

Respiratory deterioration

 Increased



 Rapid shallow breathing

 Diagnostic percussion –

Auscultation

 Bilateral inspiratory crackles

Chest Radiograph

 Bilateral fluffy infiltrates


 Air bronchograms
 Diffuse Alveolar infiltrates
 honeycomb pattern
 Ground glass appearance
 Radiopaque

Arterial Blood Gases

 Uncompensated respiratory alkalosis


 Moderate to severe hypoxemia
 Increased P(A-a)O2
Severe Acute ARDS

Oxygenation Indices
 shunt
 SvO2
Hemodynamic Values
 CVP -
 PAP -

CS
FRC
VT, RV, TLC
Sputum –
Treatment

Primarily supportive
Treatment of the precipitating problem
Mechanical ventilation

Hemodynamic monitoring –

Treatment: Mechanical Ventilation

Ventilatory strategy
 VT=
 Pplateau
 Permissive hypercapnia
 Keep pH
Treatment: PEEP

Converts areas of physiological shunt to functional gas exchange units


Increases arterial oxygenation at a lower FiO2
Increases FRC and pulmonary compliance
Goal: PEEP to obtain PaO2 > 60 mm Hg on an FiO2 < 0.60
Caution: avoid _____________________
 Decreases venous return and CO
 Increases PVR
 Barotrauma
 ↓’s CS

Use - Optimal PEEP

Level of PEEP where the best O2 del is achieved at an FiO2 of less than 0.60
Treatment: PvO2
Provides information on tissue oxygenation –
 < 35 mm Hg ►suboptimal tissue oxygenation
 Low CO ►low PvO2

Saturation of central venous blood (SVO2) < 70% is abnormal –

Treatment: Experimental Strategies

Require extensive experience


 APRV
 HFV
 TGI
 ECMO
Prone positioning
 Improves V/Q matching
 Suggested
Monitoring
Pulmonary artery catheterization allows measurement of



Pulmonary artery catheterization is controversial

Static compliance

 Stiffness of the lung


 Cst =
 Normal: 60–100 mL/cm H2O;
 Pstat measured by
 Keep Pplat
Dynamic compliance

 Also provides information on the airways


 Cdyn =
 Normal:
Weaning from Mechanical Ventilation

 MIP
 VC
 Spontaneous VT
 f/VT may be the best indicator of weaning readiness

 To measure weaning tolerance


 pH
 VDS:VT
 P(A-a)O2
 nutritional status
 cardiovascular stability
 metabolic acid–base

 Typically initiated when


 FiO2 < 0.40
 PEEP < 5 cm H2O
 f/VT < 100

You might also like

pFad - Phonifier reborn

Pfad - The Proxy pFad of © 2024 Garber Painting. All rights reserved.

Note: This service is not intended for secure transactions such as banking, social media, email, or purchasing. Use at your own risk. We assume no liability whatsoever for broken pages.


Alternative Proxies:

Alternative Proxy

pFad Proxy

pFad v3 Proxy

pFad v4 Proxy