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ACUTE RESPIRATORY DISTRESS  Decreased Lung Compliance

SYNDROME (ARDS) o Decreased aeration


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