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8 Cards in this Set
- Front
- Back
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ARDS/ALI
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-inflammatory infiltration of the lung
-altered capillary perm -accumulation of proteinaceous pulmonary edema manifesting as increased extravascular lung water |
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Direct causes of ARDs
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1. Pnemonia
2. Aspiration 3. Inhalation 4. Near- drowning |
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Indirect causes of ARDS
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*involve causes where the lung is injured secondarily in a systemic inflammatory response
1. Major trauma 2. Pancreatitis(causes so much inflamm that moves to the lungs) 3. Burns 4. Transfusion of blood products- HUGE cause 5. Drug reactions |
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4 criteria for ARDS
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1. Acute onset
2. Bilateral infiltrates on frontal chest radiograph 3. Hypoxemia (PaO2/FiO2 ratio </= 200mmHg 4. No evidence of left atrial HTN (no congestive heart failure, or pulmonary artery wedge pressure </= 18mmHg if available) |
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criteria for ALI
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1. acute onset
2. bilateral infiltrates on frontal chest radiograph 3. Hypoxemia (PaO2/FiO2 ratio </= 300mmHg) 4. No evidence of left atrial HTN |
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most cases of ARDS occur...
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24 HOURS AFTER THE INITIAL ONSET!
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Treatment for ARDS
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-low tidal volume ventilation and increased PEEP (positive end expiratory pressure) are the only strategies proven to improve survival in ALI/ARDS pts
-low tidal vol may worsen oxygenation, however this effect is tolerable given the benefits in survival accrued later for these pts |
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Additional benefits of low tidal volume
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1. Ventilator induced lung injury increased plasma cytokine concentrations in the systemic circulation and correlate with organ failure and cellular apoptosis downstream
-cytokine elaboration was reduced with low tidal volume suggesting that there may be a reduction in organ failure with this "protective" mode of ventilation |
