Acute respiratory distress syndrome: Difference between revisions
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==Background== | ==Background== | ||
*Non-cardiogenic pulmonary edema | *Non-cardiogenic pulmonary edema due to lung capillary endothelial injury | ||
**Proteinaceous material accumulate in alveoli in a heterogeneous manner | |||
*Symptom of an underlying disease | |||
==Clinical Features== | ==Clinical Features== | ||
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#PaO2/FI02 < 200 | #PaO2/FI02 < 200 | ||
#Cardiogenic pulmonary edema ruled out or wedge pressure < 18 | #Cardiogenic pulmonary edema ruled out or wedge pressure < 18 | ||
*Imaging | *'''Imaging''' | ||
**Diffuse patchy pulmonary infiltrates | **Diffuse patchy pulmonary infiltrates | ||
*'''Causes''' | |||
**[[Sepsis]] | |||
**[[Pancreatitis]] | |||
**[[Burns]] | |||
**Aspiration | |||
**Trauma | |||
**[[Submersion Injuries (Drowning)|Near drowning]] | |||
**Fat embolism | |||
**[[Amniotic Fluid Embolus|Amniotic fluid embolism]] | |||
==Differential Diagnosis== | ==Differential Diagnosis== | ||
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***Limit barotrauma to healthy area of lung | ***Limit barotrauma to healthy area of lung | ||
***Increase PEEP to improve oxygenation | ***Increase PEEP to improve oxygenation | ||
**Maintain plateau pressures < 30 | |||
==Disposition== | ==Disposition== | ||
Revision as of 16:26, 26 March 2014
Background
- Non-cardiogenic pulmonary edema due to lung capillary endothelial injury
- Proteinaceous material accumulate in alveoli in a heterogeneous manner
- Symptom of an underlying disease
Clinical Features
- Diagnostic criteria
- PaO2/FI02 < 200
- Cardiogenic pulmonary edema ruled out or wedge pressure < 18
- Imaging
- Diffuse patchy pulmonary infiltrates
- Causes
- Sepsis
- Pancreatitis
- Burns
- Aspiration
- Trauma
- Near drowning
- Fat embolism
- Amniotic fluid embolism
Differential Diagnosis
Workup
- CXR
- CBC
- Chem 10
- UA
- LFT
- Lipase
- PT/PTT
- Influenza (seasonal)
- Blood cultures
- Lactate
- Consider bedside echo
- Consider ABG/VBG
Management
- Treat underlying cause
- Cover for sepsis
- Pneumonia in addition to other identified source
- Tamiflu 75mg BID oral or NGT if influenza season [1]
- Cover for sepsis
- Ventilator Settings
- Permissive hypercapnia
- Tidal volume 6-8cc/kg of ideal body weight[2]
- Limit barotrauma to healthy area of lung
- Increase PEEP to improve oxygenation
- Maintain plateau pressures < 30
Disposition
- Admit to ICU
See Also
Sources
- ↑ http://www.cdc.gov/flu/professionals/antivirals/summary-clinicians.htm
- ↑ Brower RG, et al. "Ventilation With Lower Tidal Volumes As Compared With Traditional Tidal Volumes For Acute Lung Injury And The Acute Respiratory Distress Syndrome". The New England Journal of Medicine. 2000. 342(18):1301-1308.