acute respiratory distress syndrome
DESCRIPTION
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/FiO2TRANSCRIPT
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
• No clinical evidence for elevated LA pressure
(1994 American-European Consensus Conference Committee)
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
Evaluation of ARDS
• ABG
• CXR
• Consider bronchoscopy
• Infectious workup
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
• Airway Pressure Release Ventilation (APRV) = BiVent
• NO
• Prone positioning
• High Frequency Oscillation
• Recruitment maneuvers
Outcomes of ARDS
• 10-15% of ICU admissions
• 190,600 cases in US per year
• Approximately 41% mortality
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.