(ARDS)
Da Nang Lung
Transfusion Lung
Post Perfusion Lung
Shock Lung
Traumatic Wet Lung
Posttraumatic Failure
Posttraumatic Pulmonary Insufficiency
Wet lung
White Lung
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HISTORICAL PERSPECTIVES
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ORIGINAL DEFINITION
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REVISION OF DEFINITIONS
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1994 CONSENSUS
Acute onset
may follow catastrophic event
Bilateral infiltrates on chest radiograph
PAWP < 18 mm Hg
Two categories:
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INCITING FACTORS
Shock
Aspiration of gastric contents
Trauma
Infections
Inhalation of toxic gases and fumes
Drugs and poisons
Miscellaneous
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STAGES
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STAGES
Subacute, Proliferative phase:
persistent hypoxemia
development of hypercarbia
fibrosing alveolitis
further decrease in pulmonary compliance
pulmonary hypertension
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STAGES
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Chronic phase
obliteration of alveolar and bronchiolar spaces and pulmonary capillaries
Recovery phase
gradual resolution of hypoxemia
improved lung compliance
resolution of radiographic abnormalities
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MORTALITY
40-60% Deaths due to:
multi-organ failure
Sepsis
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PATHOGENESIS
Inciting event
Inflammatory mediators
Damage to microvascular endothelium
Damage to alveolar epithelium
Increased alveolar permeability results in alveolar
edema fluid accumulation
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PATHOGENESIS
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PATHOPHYSIOLOGY
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Cardiopulmonary interactions
Multiple organ involvement
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ABNORMALITIES OF GAS
EXCHANGE
Hypoxemia: HALLMARK of ARDS
Increased capillary permeability
Interstitial and alveolar exudate
Surfactant damage
Decreased FRC
Diffusion defect and right to left shunt
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ARDS
characterized by:
- diffuse alveolar
- capillary wall injury
- increased alveolar- capillary permiability
- noncardiogenic pulmonary edema
- hyaline membrane formation, and atelectasis
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Pathophysiology
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Pathophysiology
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Pathophysiology
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Pathophysiology
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Pathophysiology
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3. Drug Therpy
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Positive End-Expiratory
Pressure
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Cardiac Output
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Blood Transfusion
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Specific Therapies
1. Surfactant
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Specific Therapies
2.
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Antioxidant
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3. Nitric oxide
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3. Nitric oxide
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Therapies
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prone position
Study shows that prone positioning
significantly improves oxygenation in
about 65% of patients. This allows nurses
to reduce the percentage of inspired
oxygen and positive end-expiratory
pressure.
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Prone positioning
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Kinetic Therapy
Can help improve clinical outcomes and lower overall
cost of care. By continuously rotating critically ill
patients from side-to-side to at least 40, Kinetic
Therapy helps prevent and treat pulmonary
complications as ARDS
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Extracorporeal respiratory
support
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deceased complain
Interventions Nursing
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Monitor temperature.
Monitor leukocytes and albumin
Assess nutritional status.
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mechanical
ventilation, uncertainty of prognosis, and inability to
verbally communicate.
Nursing interventions
Validate sources of fear with patient.
Assess patient's perception of unmet need and
expectations.
Assist patient to identify coping skills used
successfully in the past.
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