Adult Respiratory Distress Syndrome

Front 1

ARDS

Back 1

rapid progressing, fulminating form of hypoxemic respiratory failure, often occurs in previously health persons who have sustained severe physciological insult
48-96 hours after event
high mortality rate

Front 2

causes of ARDs

Back 2

direct - pulmonary insults - pneumonia, aspiration, fat/air embolus, lung contusion, tuberculosis, inhaled toxins, chest trauma
indirect Isystemic)- shock, sepsis, pancreatitis, uremia, drug overdose, trauma, DIC, massive transfusion reactions

Front 3

ARDS pathophys

Back 3

acute lung injury - inflammatory/immune response - release of cellular mediators

Front 4

stages of ARDS

Back 4

injury/exudative statge
reparative/proliferative stage
fibrotic stage

Front 5

injury/exudative stage

Back 5

1) damage to pulmonary capillaries - increased permeabililty - fluids & proteins move into alveolar spaces (decreased compliance/hypoxia)
2) decreased surfactant production - alveoli collapse - atelectasis & decreased compliance
3) hyaline lines alveolar membrane - begins fibrosis formation - diffusion impairment begins and lungs are stiff, noncompliant

Front 6

reparative/proliferative phase

Back 6

lung tissue regenerates - dense fibrous tissue
alveolar membrane thickens (diffusion limited)

Front 7

fibrotic phase

Back 7

lungs completely remodeled - fibrous tissue is not compliant

Front 8

ARDS clinical manifestations

Back 8

tachypnea/dyspnea - accessory muscles
adventitous lung sounds (diffuse crackles)
refractory hypoxemia - hallmark sign
ABGs - o2 does not increase with therapy
cyanosis- late sign
CV sx

Front 9

ventilator association pneumonia

Back 9

good infection control to prevent
ventilator bundle protocol (elevated HOB, sedation vacation, peptic ulcer prophylaxis, venous thrombosis phrophylaxis)

Front 10

barotrauma

Back 10

overdistended alveoli rupture during mechanical ventilation (permissive hypercapnia - ventiilator with smaller tidal volume)

Front 11

volutrauma

Back 11

alveolar function - fluid and trauma in alveolar space
so vent with smaller tidal volume (permissive hypercapnia) or decrease PPV

Front 12

stress ulcer

Back 12

correct hypotension, shock, acidosids
give H2 receptro antagnosits, P pump inhibitor, carafate

Front 13

refractory hypoxemia

Back 13

hallmark sign - cannot get PaO2 up despite high flow oxygen therapy