This document discusses acute respiratory distress syndrome (ARDS) and its management. ARDS is a severe form of respiratory dysfunction that occurs in multi-organ dysfunction syndrome. It is characterized by hypoxemia, increased work of breathing, and reduced lung function requiring mechanical ventilation. Management of ARDS focuses on initial resuscitation within 6 hours to achieve certain clinical goals through fluid resuscitation and vasopressors. Antimicrobial therapy for 7-10 days and rapid source control within 12 hours are also recommended.

3. Systemic Inflamatory Response
Syndrome (SIRS)

13. ACUTE
RESPIRATORY
DISTRESS
SYNDROME
 ARDS is the prototypical expression of
respiratory dysfunction in MODS.
 In its mildest form, respiratory
dysfunction is characterized by
tachypnea, hypocapnia, and hypoxemia.
As lung injury Evolves, a combination of
worsening hypoxemia and increased
work of breathing necessitates
mechanical ventilatory support.
Impaired lung function is reflected in a
reduced PaO2.
 To ensure adequate oxygen delivery to
the tissues, mechanical ventilation must
be instituted and FIO2
 increased.
The ratio PaO2/FIO2 , therefore, is a
reliable measure of respiratory
dysfunction.

17. MANAGEMENT
• Initial Resuscitation
• Goals during the first 6 hours of resuscitation :
• CVP 8-12 mmHg
• MAP > 65 mmHg
• Urine output > 0.5 mL/kg/hour
• Central venous (superior vena cava) or mixed venous oxygen
saturation 70% or 65% respectively
• In patients with elevated lactate levels  normalize lactate
• Antimicrobial Therapy
• Duration of therapy typically 7-10 days, or longer in slow
response patients
• Source Control
• Rapidly as possible, and intervention be undertaken for
source control within first 12 hours after diagnosis is made.

18.  Vasopressor
 Target MAP > 65 mmHg.
 Norepinephrine as the first choice vasopressor.
 Epinephrine (when additional agent is needed).
 Dopamine as an alternative vasopressor to norepinephrine.
 Inotropic therapy
 Dobutamine infusion added to vasopressor in presence of
myocardial dysfunction and ongoing sign of hypoperfusion.
 Corticosteroids
 Suggest to use in adult septic shock patients if adequate fluid
resuscitation and vasopressor therapy are unable to restore
hemodynamic stability.