ARDS. g.k.kumar. ARDS. Definition Epidemiology Patient presentation and diagnosis Pathophysiology Treatment Complications. Historical background First described in 1967 by Ashbaugh et al Consensus after 1994
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Consensus after 1994
ARDS is characterized by
- Brun-Buisson et al. (2004)
• Severe pneumonia.
• Near drowning.
• Inhalation of toxins and other irritants such as smoke.
• Lung injury and bruising.
• Oxygen toxicity.
• Fat embolism- Where bubbles of fat travel through the bloodstream and block off airways.
• Shock- Including septic shock and shock due to trauma.
• Diabetic Ketoacidosis.
• Hypersensitivity reactions.
• Drugs reactions due to aspirin, heroin or paraquat.
• Multiple blood transfusions.
• Acute liver failure.
• Obstetric complications- Problems during pregnancy or delivery such as preeclampsia.
• Cardiac surgery and other complicated surgeries.
PEEP, to maintain maximal recruitment of alveolar units.
Mean airway pressure (to promote recruitment and predictor of hemodynamic effects)
Plateau pressure (best predictor of alveolar overdistention).
Advantages to APRV ventilation
Alveolar fluid clearance depends primarily on active sodium transport across the alveolar epithelium
• Pulmonary: barotrauma (volutrauma), pulmonary embolism (PE), pulmonary fibrosis, ventilator-associated pneumonia (VAP).
• Gastrointestinal: hemorrhage (ulcer), dysmotility, pneumoperitoneum, bacterial translocation.
• Cardiac: arrhytmias, myocardial dysfunction.
• Renal: acute renal failure (ARF), positive fluid balance.