Acute respiratory distress syndrome: Difference between revisions
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****Ardsnet PEEP/FiO2 [http://www.ardsnet.org | ****Ardsnet PEEP/FiO2 [http://www.ardsnet.org/files/ventilator_protocol_2008-07.pdf protocol card]<ref>Kallet RH, et al. "Respiratory controversies in the critical care setting. Do the NIH ARDS Clinical Trials Network PEEP/FIO2 tables provide the best evidence-based guide to balancing PEEP and FIO2 settings in adults?" Respiratory Care. 2007. 52(4):461-75.</ref> | ||
**Maintain plateau pressures < 30 <ref>Hansen-Flaschen et al. Acute respiratory distress syndrome: Clinical features and diagnosis.UpToDate accessed 3/26/14</ref> | **Maintain plateau pressures < 30 <ref>Hansen-Flaschen et al. Acute respiratory distress syndrome: Clinical features and diagnosis.UpToDate accessed 3/26/14</ref> | ||
**Ensure adequate sedation | **Ensure adequate sedation | ||
Revision as of 00:04, 13 June 2015
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[1]
- New onset respiratory symptoms
- Bilateral pulmonary opacities
- Symptoms not explained by cardiac etiology or volume overload
class="wikitable"
- Presentation
- Severe dyspnea
- Hypoxemia
- Diffuse crackles
- Imaging
- Diffuse patchy pulmonary infiltrates
- Causes
- Sepsis
- Pancreatitis
- Burns
- Aspiration
- Trauma
- Near drowning
- Fat embolism
- Amniotic fluid embolism
- Overdose
Differential Diagnosis
Pulmonary Edema Types
Pulmonary capillary wedge pressure <18 mmHg differentiates noncardiogenic from cardiogenic pulmonary edema[2]
- Cardiogenic pulmonary edema
- Noncardiogenic pulmonary edema
- Negative pressure pulmonary edema
- Upper airway obstruction
- Reexpansion pulmonary edema
- Strangulation
- Neurogenic causes
- Iatrogenic fluid overload
- Multiple blood transfusions
- IV fluid
- Inhalation injury
- Pulmonary contusion
- Aspiration pneumonia and pneumonitis
- Other
- High altitude pulmonary edema
- Hypertensive emergency
- ARDS
- Flash pulmonary edema
- Immersion pulmonary edema
- Hantavirus pulmonary syndrome
- Missed dialysis in kidney failure
- Naloxone reversal
- Negative pressure pulmonary edema
Workup
- CXR
- CBC
- Chem 10
- UA
- LFT
- Lipase
- PT/PTT
- Influenza (seasonal)
- Blood cultures
- Lactate
- Consider bedside echo
- Consider ABG/VBG
- Consider BNP
Management
- Treat underlying cause
- Cover for sepsis
- Pneumonia in addition to other identified source
- Tamiflu 75mg BID oral or NGT if influenza season [3]
- Cover for sepsis
- Supplemental O2
- Noninvasive ventilation
- Limited data to support use
- Ventilator Settings
- Permissive hypercapnia
- Tidal volume 6-8cc/kg of ideal body weight[4]
- Limit barotrauma to healthy area of lung
- Increase PEEP to improve oxygenation
- Ardsnet PEEP/FiO2 protocol card[5]
- Maintain plateau pressures < 30 [6]
- Ensure adequate sedation
- Better synchrony with vent
- Decreased oxygen consumption
- Less delirium
- Increased patient comfort
- Prone ventilation
- Preliminary data suggests prone positioning may increase survival
- Consider for refractory hypoxemia
Disposition
- Admit to ICU
See Also
Sources
- ↑ Ferguson ND et. al. The Berlin definition of ARDS: an expanded rationale, justification, and supplementary material. Intensive Care Med. 2012 Oct;38(10):1573-82.
- ↑ Clark SB, Soos MP. Noncardiogenic Pulmonary Edema. In: StatPearls. Treasure Island (FL): StatPearls Publishing; October 1, 2020.
- ↑ 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.
- ↑ Kallet RH, et al. "Respiratory controversies in the critical care setting. Do the NIH ARDS Clinical Trials Network PEEP/FIO2 tables provide the best evidence-based guide to balancing PEEP and FIO2 settings in adults?" Respiratory Care. 2007. 52(4):461-75.
- ↑ Hansen-Flaschen et al. Acute respiratory distress syndrome: Clinical features and diagnosis.UpToDate accessed 3/26/14