o Fibrosis Acute Lung Injury Increased Etiology Vascular Permeability Results to o Sepsis – most common cause, Edema and Decreased Aeration especially in alcoholics (decreased glutathione in lungs) o Pneumonia – most likely nosocomial o Aspiration – commonly gastric contents (assoc. TEF) o Severe trauma – bilateral lung contusion, lung bone fractures (fat emboli, 12-48 hours) o Massive blood transfusions - >15 units o Stem cell transplant (Lung/Bone Marrow) – primary graft failure (2-3 days post) o Drug Overdose: alcohol, aspirin, cocaine, opioids, phenothiazine Idiosyncratic: protamine, nitrofurantoin, chemotherapy Other Causes o Smoking o Cardiopulmonary bypass o Thoracic surgery o Pneumonectomy o Acute pancreatitis o Obesity o Blood type A o Near drowning Clinical Condition o Inciting event 6-72 hours symptomatic rapidly worsens Three Stages o Exudative Stage diffuse alveolar damage Effects: fluid accumulation (usually <7days) Decreased Gas Exchange Manifestations: o VQ mismatch – ventilation Dyspnea perfusion mismatch is a ratio Cyanosis used to assess the efficiency and (hypoxemia) adequacy of the matching of two Diffuse crackles variables: V – ventilation – the air (fluid) that reaches the alveoli. Q – RR/HR perfusion – the blood that Diaphoresis reaches the alveoli via the Use of accessory capillaries muscles for o Physiologic Shunting – right to breathing left shunting Cough o Hypoxemia – decrease Oxygen in blood Chest pain o Proliferative Stage Diffuse Alveolar Resolution of pulmonary Hemorrhage edema (7-10 days) Hemoptysis Alveolar type II cells – low H/H squamous metaplasia bronchoalveolar Interstitial myofibroblasts lavage (BAL) – Symptoms improve, frothy blood, RBC, unless go to Fibrotic stage hemosiderin laden o Fibrotic Stage macrophage Obliteration of normal Cancer lung sometimes so rapid Diffuse fibrosis mimics ARDS Cysts formation Severity of ARDS Medical Approach o Mild – 200-300 Long term MV and o Moderate – 100-200 O2 o Severe - < 100 Biopsy Medical Management Diagnostic Investigations 1. Supplemental O2 o ABG – decreased O2, Acute Intubation and MV Respiratory Acidosis Low tidal volume ventilation – o CXR – diffuse bilateral alveolar prevent ventilator induced lung infiltrates injury; alveolar over distention o CT Scan – widespread and collapse patchiness, air bronchogram PEEP: the setting in the MV that Diagnosis maintains positive pressure o Respiratory symptoms - <1 week within the lungs at the end of of inciting event expiration, which increases the o CXR/CT Scan – opacities residual capacity, reducing o Rule out other conditions: hypoxia Cardiogenic pulmo edema 2. Supportive no murmur (s2/s4) Sedation – increase tolerance to no increase in MV; decrease O2 consumption jugular vein (LORAZEPAM) pressure Paralysis – if sedation is no cardiomegaly inadequate (NM BLOCKER; venous congestion Succinylcholine) Kerley B-lines Opioid – pain relief B-type Natriuretic (FENTANYL/MORPHINE) Peptide (BNP) Fluid Management – decrease Blood test left atrial filling pressure – 100pg/ml decrease PE; CVP <4mmHg while echocardiogram – maintaining adequate organ normal heart perfusion (esp. kidneys) (FLUID findings RESTRICTION, DIURETICS) PCWP <18mmHg Nutritional Support – high Interstitial lung disease catabolic state, high nutrition (acute exacerbation) requirements (ENTERAL clinical findings FEEDING) CXR Glucose Control DVT/GIT Prophylaxis 3. Treat underlying cause Monitor Most common cause of death PAP (N – 10-20 Not directly from respiratory mmHg) and PCWP failure (N – 4-12 mmHg) 4. Other Therapies CVP, cardiac Surfactant/Antioxidants – no output, peripheral evidence perfusion Nitric Oxide, Prostacyclin (PGI), Intake and Output Prostaglandin (PGE) – no Bleeding improvement in outcomes tendencies, Glucocorticoids/Corticosteroids - potential for DIC <2weeks – uncertain; 2 weeks – Protect from Infection harmful Strict aseptic Human Mesenchymal Stem Cell technique – evidence shows optimistic Antibiotic therapy results Provide Physiological Nursing Management Support o Assist in respirations Maintain nutrition May require MV to Skin Care maintain respiration o Health Teachings May need to be Briefly explain procedures transferred to ICU as they are happening May need O2 to combat (emergency situation can hypoxia frighten the patient) Suction PRN Give rationale for follow Monitor ABG up care If not on MV, asses VS Identify risk factors as and respiratory status appropriate for prevention every 15 minutes of recurrence Cough, deep breath every o Outcomes hour Maintain adequate gas May need: chest exchange percussion, vibration; Communication reduction postural drainage, in anxiety suction; bronchodilator Performs activities without medications respiratory distress or o Prevent Complications fatigue Decrease anxiety and provide psychological care Maintain calm atmosphere Encourage rest to conserve energy Emotional Support Obtain Fluid Balance Slow IV flow rate Diuretics: rapid acting, low dose