THIS IS AN BRIEF INFORMATION ABOUT AN ONE OF MY FAVOURITE SUBJECT ARDS & & ITS MANAGEMENT ,ROLES OF INTENSIVE NURSES , IT WILL EXPLAINS ABOUT CATEGORIES, PF RATIO, PRONE POSITIONING & NURSING CARE .....FOR THIS I REFFERED OLD SLIDE SHARE PPTS & IN HOSPITAL ROUTINELY PRACTICING POLICIES
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ARDS MEANING,MANAGEMENT . PRONE POSITIONING & NURSES ROLE
1.
2. ARDS
ACUTE RESPIRAORY DISTRESS SYNDROME DEFINED AS A -
“ SYNDROME OF ACUTE & PERSISTENT LUNG INFLAMMATION WITH
INCREASED VASCULAR PERMEABILITY (HANSEN –FLETCHER ET AL)”
AS WE KNOW ITS AN ACUTE LUNG CONDITION IN WHICH
PERSON SUSCEPTIBLE TO GET RESPIRATORY FAILURE/ARREST ; MAY
LEEDS TO CARDIAC ARREST & DEATH ………..
LUNG INFECTION(FLUID BUILD UP)----LUNG PARENCHYMAL
DESTRUCTION(INFLAMMATION ) ----ARDS---RESPRATORY FAILURE/ARREST----
CARDIAC ARRSET –DEATH
3. ARDS
Clinically ARDS is characterized by:
Acute onset ( <48hrs)
Bilateral lung infiltrates
Pao2/fio2 ratio <300mmhg
No evidence of cardiac CAUSES
CONSTANTLY RISING HIGH PEEP & FIO2 (PEEP >10 & FIO2 >95% )……
5. PF RATIO-
PF RATIO =Partial pressure of oxygen / fraction of inspired oxygen
( pao2/fio2 )
Example pao2 is 147 , fio2 is 50% ( 0.5) ,
Pf ratio= 147/0.5 i.e 294 …
Pf ratio is 294 so its mild ARDS ……….
6. DIAGNOSIS-
***EXAMINATION OF THE AIR WAY– Auscultation
,percussion etc….
***SWABS throat or nose –To help to identify any viruses….
*** LAB INVESTIGATIONS – CBC, pleural fluid analysis Etc…..
*** CHEST X RAY or CT CHEST – To determine if there is fluid
in the air sacs of the lungs
7. TREATMENT OF ARDS -
>.ANTIBIOTICS
>.BLOOD THINNING MEDICATIONS OR AIDS – Example-heparin , compression
stockings ( to reduce the risk of clots )
>.NUTRITION SUPPORT –To maintain Normal micro & macro nutritional balance …..
>.OYGEN THERAPY – based on severity NASAL CANULLA—FACE MASK– NRBM—
HFNC—BIPAP- NIV—INTUBATION etc……
8. ARDS MANAGEMENT
TREATMENT OF ARDS ,IT SHOULD MAINLY
INCLUDES-
** Treating underlying cause ex-sepsis,Diabetic
keto acidosis, nutritional balance etc…..
**Lung protective ventilation ( low vt+adequate
PEEP)
**Avoid a positive fluid balance
However , in severe cases of ARDS(low PH , low
o2 & high co2 & increasing PEEP Pressure
)standard therapy may fail…..
Main Rescue therapy is PRONE
POSITIONING ……
9. BASED ON PF RATIO , ARDS
MANAGEMENT PROTOCALS
**INCREASING PEEP & FIO2 –if PF ratio dropped less than <300mmhg…
** PRONE POSITIONING IF pf ratio falls below than <200mmhg…
** ECMO ( V-V TYPE OF ECMO)- if pf ratio falls below than <75mmhg..
**Lung transplantation –because of more complications& difficult feasibility ,
generally not practicing…….
10. PRONE POSITIONING …..
MAIN INDICATIONS-
** ARDS
** <48HRS ONSET HISTORY
** PF RATIO <200MMHG
RELATIVE CONTRAINDICATIONS FOR THE PRONE POSITIONING-
Elevated ICP
, Intestinal ischemia,obesity,recent abdominal surgery
ABSOLUTE CONTRAINDICATIONS FOR PRONE POSITION-
Spinal cord, instability,unstagable facial fracture,anterior burns, open abdomen ,
increased abdominal pressure , unstagable pelvic fractures….
11. PRONE POSITION-
Indicated –
Moderate to severe ARDS
Early (48hours of ARDS)
DURATION – based on intensivist order ,Usually 12-20hours is recommended….
Prone position improves-
**improves perfusion to the lungs
**the diaphragm drops & heart shift forward—improved compliance
**improves lung recruitment
**lung protective …
12. PRONE POSITION
cont……
**may lowers airway pressure
**may improve VT & MV (DECREASES CO2)
**Reduce the risk of atelectotrauma,barotrauma &volutrauma….
RECOMMENDED CYCLES-
As per physician or intensivist advice usullay 6-14cycles ( based on response)…..
13. PRONE POSITION
NURSING CARE-
Ensure adequate sedation & analgecia ( meet goal RASS ) …
Securing of all lines & tubes , so avoid interruptions….
ABG PRN to assess oxygenation ( pao2) & ventilation ( paco2) & VBG once daily ….
Reposition of arms 2nd hourly …
Head position changing 4th hourly…
Nutrition –minimal feed therapy 10-20ml/hr , to reduce the risk of aspiration & parenteral
nutritional therapy ….
Check q2h for pressure areas ….
Family education ….
14. NURSING MANAGEMENT
SPECIAL CONSIDEARTIONS-while handling proned patients
**monitor vital signs & urine out put….
Minimal NGT or OGT feed ( avoid aspiration) ….
check frequently plateu pressure & Ppeak in ventilator ( et tube free from
secretions)
**Frequant head position & arms postion changing ..
**approach doctors for daily chest X ray &electrolytes corrections as per
intensivist…….
*ABG IS MUST & SHOULD DO ; 1 HOUR BEFORE PRONE & 1HOUR AFTER THE
PRONE ”….ABG MUST & SHOULD DO ; ONCE SUPINED NEED TO DO WITHIN 1 TO 4
HOURS…
6TH HORLY ABG ,DAILY RFT NEEDED AS PER PHYSICIAN ORDERS …