Acute respiratory distress syndrome: Difference between revisions
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#Bilateral pulmonary opacities | #Bilateral pulmonary opacities | ||
#Symptoms not explained by cardiac etiology or volume overload | #Symptoms not explained by cardiac etiology or volume overload | ||
'''PaO2/FIO2 ratio''' | '''PaO2/FIO2 ratio''' | ||
*200-300 Mild | *200-300 Mild | ||
*100-200 Moderate | *100-200 Moderate | ||
*< 100 Severe | *< 100 Severe | ||
*'''Presentation''' | *'''Presentation''' | ||
Revision as of 18:28, 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[1]
- New onset respiratory symptoms
- Bilateral pulmonary opacities
- Symptoms not explained by cardiac etiology or volume overload
PaO2/FIO2 ratio
- 200-300 Mild
- 100-200 Moderate
- < 100 Severe
- Presentation
- Severe dyspnea
- Hypoxemia
- Diffuse crackles
- 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
- 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 [2]
- 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[3]
- Limit barotrauma to healthy area of lung
- Increase PEEP to improve oxygenation
- Maintain plateau pressures < 30 [4]
- 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.
- ↑ 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.
- ↑ Hansen-Flaschen et al. Acute respiratory distress syndrome: Clinical features and diagnosis.UpToDate accessed 3/26/14