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Acute Respiratory Distress Syndrome. Taylor Wofford, MD UNC Internal Medicine July 14, 2009. Over the years…. Shock lung Wet lung DaNang lung Stiff lung Pump lung … Actut Respiratory Distress Syndrome. ARDS. PaO2/FiO2 <200 Acute onset Bilateral infiltrates c/w pulmonary edema

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Acute respiratory distress syndrome

Acute Respiratory Distress Syndrome

Taylor Wofford, MD

UNC Internal Medicine

July 14, 2009


Over the years
Over the years…

  • Shock lung

  • Wet lung

  • DaNang lung

  • Stiff lung

  • Pump lung

  • Actut Respiratory Distress Syndrome


ARDS

  • PaO2/FiO2 <200

  • Acute onset

  • Bilateral infiltrates c/w pulmonary edema

  • No clinical evidence for elevated LA pressure

    (1994 American-European Consensus Conference Committee)


Pathophysiology
Pathophysiology

ARDS

Normal lung


Causes of ards

Sepsis

Aspiration

Pneumonia

Severe trauma/burns

Massive blood transfusion

TRALI

Relief of airway obstruction

Lung and BMT

Drug overdose

Pancreatitis

Near drowning

Smoke inhalation

Cardiopulmonary bypass

Venous air embolism

Neurogenic pulmonary edema

Causes of ARDS


Evaluation of ards
Evaluation of ARDS

  • ABG

  • CXR

  • Consider bronchoscopy

  • Infectious workup


Management of ards
Management of ARDS

  • Mechanical ventilation

    • Vt <6 mL/kg

    • PIP goal <40 cmH20

    • Permissive hypercapnea

    • High PEEP

    • Pressure mode > volume mode

    • FiO2 as low as possible

      • ARDS Network Study


Notable options
Notable options

  • Airway Pressure Release Ventilation (APRV) = BiVent

  • NO

  • Prone positioning

  • High Frequency Oscillation

  • Recruitment maneuvers


Outcomes of ards
Outcomes of ARDS

  • 10-15% of ICU admissions

  • 190,600 cases in US per year

  • Approximately 41% mortality


Bibliography
Bibliography

  • Evans TW. Respiratory Management in Critical Care. BMJ, 2004.

  • Fishman, AP. Shock lung: A distinict nonentity. Circulation 1973;47;921-923.

  • Green GB et al. The Washington Manual of Medical Therpeutics, 31st ed. Philadelphia: Lippincott Williams & Wilkins, 2004.

  • Husain AN. Pulmonary Pathology. www.meddean.luc.edu.

  • Siegel, MD. Acute respiratory distress syndrome: Pathophysiology; clinical manifestations; prognosis; and outcome. UpToDate.com, 2009.


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