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Acute Respiratory Distress Syndrome

Figure 27-1. Adult respiratory distress syndrome.


Slide 1

Copyright 2006 by Mosby, Inc.

Introduction

ARDS is characterized by noncardiogenic pulmonary


edema, lung inflammation, hypoxemia, and decreased
lung compliance.
ARDS is in fact a collection of different diseases that
have not yet been separately identified.

Interstitial and intra-alveolar edema and hemorrhage

Alveolar consolidation

Pulmonary surfactant deficiency or abnormality

Atelectasis

Slide 2

Copyright 2006 by Mosby, Inc.

Etiology:
Multitude of Factors
In alphabetical order, some of the better-known causes

Slide 3

Aspiration

Central nervous system disease

Congestive heart failure

Disseminated intravascular coagulation

Drug overdose

Fat or air emboli

Infections

Inhalation of toxins and irritants


Copyright 2006 by Mosby, Inc.

Alveolar Epithelial Basement Membrane Breakdown

Damage to Vascular Endothelium


Third Spacing of Protein-Rich fluid

Flooding of Alveoli

Type II cells damaged:


Less Surfactant
Diminished fluid removal

Slide 4

Platelet Aggregation

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Clinical Data Obtained at the


Patients Bedside

Slide 5

Increased respiratory rate

Increased heart rate, respiratory rate, blood


pressure

Substernal/intercostal retractions

Cyanosis leads to hypoxia

Difficulty of breathing

Chest assessment findings

Dull percussion note

Crackles
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Diagnosis
ARDS was defined as a syndrome of :
1- Acute onset (developed respiratory distress within 48
to 72 hours )
2- Bilateral infiltrates on CXR consistent with pulmonary
edema
3-Arterial blood gas reveals decrease PO2(less than
60mmhg) despite administration of high O2..

Slide 6

Copyright 2006 by Mosby, Inc.

1 - Supportive Care

Slide 7

One of the first goals of therapy in ARDS is to treat


the underlying cause.
In particular, patients with sepsis may respond to
aggressive source control, including antibiotics.
Prophylaxis against gastrointestinal stress ulceration
and deep venous thrombosis.
Prone position-Better ventilation-perfusion matching

Copyright 2006 by Mosby, Inc.

General Management of
ARDS
Medications and procedures commonly
prescribed by the physician

Slide 8

Antibiotics

Diuretics

Corticosteroids

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8 - Mechanical Ventilation

Slide 9

Mechanical ventilation is lifesaving and is


the standard therapy for ARDS.
Ventilatory management of ARDS has
undergone a dramatic change within the last
15 years.

Copyright 2006 by Mosby, Inc.