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11 Cards in this Set
- Front
- Back
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ARDS definition
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- Acute onset of hypoxemic resp failure w/ bilateral infiltrates on CXR
– PA wedge pressure <18 or no evidence of left atrial hypertension (no cardiogenic back pressure) – if PaO2/FIO2 < 300, Acute Lung Injury – if PaO2/FIO2 < 200, ARDS |
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Systemic Inflammatory Response Syndrome (SIRS)
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systemic response to a variety of processes and fever, tachypnea, tachycardia, leukocytosis
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ARDS etiology - direct lung injury
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- Pneumonia and Aspiration are the main ones
– also from Pulmonary Contusion, Fat Emboli, Inhalational Injury, or Near Drowning |
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ARDS etiology - indirect lung injury
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- Sepsis, Multiple Trauma, and Other Shock are the main ones
– also from Acute Pancreatitis, Multiple Transfusions, Drug Toxicity |
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Systemic Inflammatory Processes and SIRS
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- Endotoxin and other bacterialproducts ->
- Release of 2o inflam mediators and Activation of coagulation and Complement activation -> - Hypotension and Tissue damage – you have a runaway immune system |
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Activated protein C and ARDS
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- APC does antithrombotic effect (Va and VIIIa) and an indirect anti-inflam
– it inhibits proinflamm cytokine production, (TNF-a from monocytes), & selectins – a profibrinolytic effect by inhibiting PAI-1 and preventing TAFI activation |
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Septic shock (warm shock)
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– Inflam Cytokines -> NO from Vasc. Endothelium -> Low Systemic Vascular R -> high CO Hypotension
- Wide pulse pressure, Brisk capillary refill, Hyperdynamic – there is Decreased urine output, decreased mental status, and lactic acidosis |
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Acute or exudative phase of ARDS
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- exposure to a RF -> alveolar cap Injury or Epi Cell Injury -> Leak of Protein Rich Fluid into Interstitium and Alveolus
- Arterial hypoxemia refractory to oxygen, Bilateral patchy infiltrates, Decreased lung compliance, and rapid onset respiratory failure |
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Proliferative or Fibrotic Phase of ARDS
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- Fibrosing Alveolitis in procollagen III peptide present day 1 or 2, Histologic changes day 5-7
- Clinical Evidence Day 5-10 is persistant hypoxemia, ↑ dead space, Further ↓ in compliance, Pulmonary hypertension, and Obliteration of pulmonary capillary bed |
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Recovery phase of ARDS
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Gradual resolution of hypoxemia, improved lung compliance, resolution of radiographic abnormalities, and normalization of PFT’s (DLCO delayed resolution)
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ARDS treatment
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Treat the underlying source and support the pt w/ low pressure/low stretch ventilation
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