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CABUG-OS, MEKE P.

Pathophysiology of Acute Respiratory Distress Syndrome

Etiology:
Predisposing Factor: Injury to the lungs that damages Precipitating Factors:
the vascular endothelium and
 Age (75-84 endothelial lining of the alveoli  Aspiration
years old)  Drugs, Toxins,
and Therapeutic
Agents
 Infections
 Trauma and
Shock

Damage to the Sx: Damage to the epithelial


vascular endothelium  Fever lining of the alveoli

Increases capillary
Platelet aggregation and
permeability
intravascular thrombus
formation

Influx of protein-rich fluid


into the alveolar space Platelets release substances that
attract and activate neutrophils
and complement cascade

A
B
B

Neutrophils release
inflammatory mediators

Damages the respiratory


membrane and alveolar cells

A Increases capillary permeability

Sx:
 Crackles
Pulmonary edema and Dx Test:
 Dyspnea
hemorrhage  Chest X-Ray

Mgt.:
 Diuretics If unmanaged If managed FAIR PROGNOSIS

Mgt.:
S/Sx:  Use of PEEP
Decrease pulmonary ventilation and  Anxiety mechanical
compliance  Severe dyspnea ventilator
 Arterial hypoxemia  Supplemental
oxygen
Hyaline membrane forms

Assessment:
C  ABG Analysis
C

Fibrosis progressively
obliterates the alveoli,
respiratory bronchioles, and
interstitium

Pulmonary
hypertension
Multi-organ failure

Right ventricular failure Respiratory failure


Decrease cardiac
output; decrease
oxygenated blood in
Congestion of the viscera S/Sx: systemic circulation
and peripheral tissues  JVD
 Edema
Decrease in renal
perfusion
Blood backs up in the
hepatic veins Mgt.: S/Sx:
 Diuretics  Sharp decrease
Decrease GFR in u.o.
 Increase
Liver becomes BUN and crea.
engorged level
Further decrease in GFR

D E
D E

Increase pressure within the Accumulation of nitrogenous wastes;


portal vessels alterations in water, electrolyte, and acid-base
balance; inactivation of Vitamin D; disruption
in erythropoietin production
Portal hypertension
Overwhelming infection

Development of high pressure Mgt.:


Force fluid into the abdominal cavity gradient between portal vein and If  Anti
inferior vena cava unmanaged biotics
S/Sx:
 Abdominal Ascites
pain Venous collaterals develop DEATH
 Anorexia
 Nausea If unmanaged
Abnormal varicoid vessels
Mgt.:
 Diuretics Spontaneous bacterial
peritonitis Prone to rupture and bleeding
 Paracentesis
 Sodium
restriction
Mgt.: Diagnostic
 If unmanaged Bleeding
 Antibi Test:
otics
 Endoscopy
If unmanaged
Sepsis

Hemorrhagic
Shock
DEATH