Acute respiratory distress syndrome

Revision as of 15:57, 26 March 2014 by Alinker (talk | contribs) (new note)

Background

  • Non-cardiogenic pulmonary edema

Clinical Features

  • Diagnostic criteria
  1. PaO2/FI02 < 200
  2. Cardiogenic pulmonary edema ruled out or wedge pressure < 18
  • Imaging
    • Diffuse patchy pulmonary infiltrates

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]
  • Ventilator Settings
    • Permissive hypercapnia
    • Tidal volume 6-8cc/kg [2]
      • Limit barotrauma to healthy area of lung
      • Increase PEEP to improve oxygenation
        • Maintain plateau pressures < 30

Disposition

  • Admit to ICU

See Also

Sources

  1. ↑ http://www.cdc.gov/flu/professionals/antivirals/summary-clinicians.htm
  2. ↑ 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.
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