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Adult (Acute Respiratory Distress Syndrome

Adult (Acute Respiratory Distress Syndrome. Paramedic Program Chemeketa Community College. What in the heck is ARDS?. A fulminent form of respiratory failure Noncardiac pulmonary edema Acute lung inflammation Diffuse alveolar-capillary injury ~ 200,000 cases per year Mortality 40-70%

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Adult (Acute Respiratory Distress Syndrome

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  1. Adult (Acute Respiratory Distress Syndrome Paramedic Program Chemeketa Community College

  2. What in the heck is ARDS? • A fulminent form of respiratory failure • Noncardiac pulmonary edema • Acute lung inflammation • Diffuse alveolar-capillary injury • ~ 200,000 cases per year • Mortality 40-70% • Severe hypoxia

  3. Intrapulmonary shunting • Reduced lung compliance • Irreversible parenchymal lung damage • Usually healthy lungs before event • More common in men

  4. Trauma Direct pulmonary injury Multiple trauma A complication of injury or illness • Gram-negative sepsis • Gastric aspiration • Cardiopulmonary bypass surgery

  5. Multiple blood transfusions Oxygen toxicity Toxic inhalation Pneumonia OD (tricyclics, heroin, methadone, barbiturates, salicylates) Infections Drowning (12-24 hours) Complications, cont.

  6. Yes, but what happens? • Increased capillary permeability = wet congested lungs; decreased perfusion capacity • Decreased pulmonary compliance • Requires higher airway pressure

  7. 3 phases • Exudative phase – injury to endothelium and epithelium, inflammation, fluid exudation • Fibroproliferative phase – influx and proliferation of fibroblasts; injury may begin to resolve or become persistant • Fibrosis phase – resolution of inflammation; development of pulmonary fibrosis

  8. Diffuse Alveolar Damage

  9. The patient • Onset w/in 72 hours • Mild tachypnea may be only manifestation • Labored breathing, tachypnea • Cyanosis • Moist skin • Hyperventilation • Scattered crackles/rales

  10. Absent signs of volume overload • 3rd heart sound • JVD • Agitation • Lethargy • Obtundation

  11. DDX • CHF • Pulmonary edema • Aspiration pneumonia • Bacterial pneumonia • Immunocompromised pneumonia • Viral pneumonia • Smoke inhalation • Cardogenic pulmonary edema

  12. Complications • Respiratory failure • Cardiac dysrhythmias • Disseminated intravascular coagulation • Barotrauma • Congestive heart failure • Renal failure • Multiple organ failure

  13. Management • Always – high oxygen • Sa02 • IV • ET prn • PEEP or CPAP • Maintain Sa02 at 92-94% • Fluid replacement to maintain cardiac output

  14. Management, cont. • Corticosteroids - controversial • Diuretics • Consider Dobutamine • 2.5 mcg/kg/min; titrate to effect

  15. Work up in the ED • ABG’s • CXR • Sputum collection

  16. Important to recognize • Patients who have been resuscitated may have a period of relative stability followed by deterioration

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