This document provides information about acute respiratory distress syndrome (ARDS) including its definition, causes, pathophysiology, symptoms, diagnostic evaluation, management, and prognosis. ARDS is a life-threatening lung condition caused by fluid buildup in the lungs which prevents proper oxygen exchange. The document outlines the three phases of ARDS, symptoms, diagnostic tests, treatment options including ventilation strategies and positioning, and complications. Prone positioning is highlighted as an effective strategy to improve outcomes when used early in patients with severe hypoxemia.
2. At the end of the class the students will be
able to:
1. Define ARDS
2. List the causes and risk factors
3. Explain the pathophysiology
4. List the symptoms and complications
5. List the diagnostic evaluation
6. Enumerate the management
7. Discuss the 5 P’s of ARDS
3.
4.
5. Life-threatening lung injury that allows fluid
to leak into the lungs
Fluid builds up inside the tiny air sacs of the
lungs, and surfactant breaks down
Prevent the lungs from properly filling with
air and moving enough oxygen into the
bloodstream and throughout the body.
6.
7.
8. The lung tissue may scar and become
stiff.
One way to assess the degree of
impairment of gas exchange is to
measure the PaO2/ FiO2 (P/F) ratio.
Normally P/F ratio would be greater than
400.
9. When the P/F ratio is 200-300 it is
termed as Acute Lung Injury.
The term ARDS is used when the P/F
ratio is less than 200.
10. Acute respiratory distress syndrome is a
sudden and progressive form of acute
respiratory failure in which the alveolar
capillary membrane becomes damaged and
more permeable to intravascular fluid
resulting in severe dyspnea, hypoxemia and
diffuse pulmonary infiltrates.
11. Fast onset
Usually already hospitalized with
another condition
Develops due to systemic
inflammation
12.
13. In US ranges from 64.2 to 78.9
cases/100,000 person-years.
25% cases are initially classified as mild,
and 75% as moderate or severe.
In India, nearly 30% of the cases of ARDS
are due to Pneumonia.
14. Sepsis
Inhalation of harmful substances
Severe pneumonia
Head, chest or other major injury
Covid- 19
16. 24 hours after injury
Fluid starts to leak( Protein rich)
Enters interstitium Pulmonary edema
Surfactant cell damage
Unstable alveolar sac Collapse
Atelectesis
17. Hyaline membrane (made of dead cells and
proteins
Lungs less elastic, Lung compliance
VQ mismatch (Ventilation and perfusion)
Hallmark sign: Refractory hypoxemia
18. If a patient’s oxygen requirements
continue increasing while oxygen
saturation levels remain low, ALI is
progressing to ARDS. This condition is
called refractory hypoxemia.
19. 14 days after injury
Grow and reproduce cell quickly
Repair structure, reabsorption of fluid
Dense and fibrous lung tissue
Decreased lung compliance
Worse hypoxemia
20. 3 weeks after injury
Fibrosis of lung tissue, lung damage
Poor prognosis
21. Severe shortness of breath
Labored and unusually rapid breathing
Confusion and extreme tiredness
Fast heart rate
Coughing that produces phlegm
22. Extreme tiredness
Fever
Crackling sound in the lungs
Chest pain, especially when trying to
breathe deeply
Blue fingernails or blue tone to the skin
or lips
29. Supplemental oxygen
Acid-reducing medicines eg.Pantoprazole
Antibiotics like tetracyclines
Blood thinners
Muscle relaxants like succinylcholine
Sedatives like midazolam and lorazepam
30.
31.
32. Ineffective breathing pattern related to
decreased lung function as evidenced by
dyspnea and cyanosis.
Impaired gas exchange related to
diffusion defect as evidenced by hypoxia,
tachycardia and cyanosis.
33. Administer oxygen therapy
Monitor oxygen saturation
Encourage the patient to practice deep
breathing and coughing exercise
Administer prescribed bronchodilator
Position the patient in semi-fowler or high
fowler position
34. Risk for impaired skin integrity related to
prolonged bed rest and immobility.
Intervention:
Assess the patient’s skin regularly
Reposition the patient every 2 hours
Use skin care products
Use pressure relieving devices
Encourage the patient for range of motion.
35. Knowledge deficit related to health condition,
hospitalization as evidenced by frequent
questioning
Intervention:
Educate the patient and family about the disease
condition, its signs and symptoms, treatment and
prognosis.
Educate about infection prevention, nutrition and
rehabilitation.
36. Closely monitor and recognize changes in
the patient’s condition.
Monitor the vitals closely
Maintain airway
Provide Oxygenation
Restrict fluid intake as prescribed
38. The goal of care for ARDS patients is
to maximize perfusion in the
pulmonary capillary system by
increasing oxygen transport between
the alveoli and pulmonary capillaries.
39. To achieve the goal:
Increase fluid volume without overloading
the patient.
Blood transfusions
Certain drugs can also help increase perfusion
Inotropics such as dobutamine
Vasopressors (norepinephrine and dopamine)
40. Three positioning therapies can
decrease these complications and
improve perfusion in ARDS patients:
i. Kinetic Therapy
ii. Continuous lateral rotational therapy
iii. Prone positioning
41. By continuously rotating critically ill
patients from side to side to at least
40 degree, gravitational pressure can
help in improving ventilation
perfusion mismatch and help in
improving oxygenation and benefit
patients with ALI/ ARDS
46. The primary goal of ventilation is to
support organ function by providing
adequate ventilation and oxygenation
while decreasing the patient’s work
of breathing.
47. Current recommendations for protective
lung ventilation include:
Limiting plateau pressures to less than
30 cm H2O
Reducing FiO2 to 50% to 60%,
48. Weaning protocols can reduce the time
and cost of care while improving
outcomes for ARDS patients.
49. Evidence-based guidelines suggest the
following:
using spontaneous breathing trials
instead of synchronous intermittent
mechanical ventilation.
50. Using sedation goals to reduce the
duration of mechanical ventilation
and ICU length of stay.
58. Elevation of bed (30 degree- 45 degree)
Daily oral care with chlorhexidine
Daily sedation vacation
Position change every 2 hours
Daily assessment of readiness to extubate
63. The effects of prone position ventilation in
patients with acute respiratory distress
syndrome. A systematic review and
metaanalysis
Author: J.A. Mora-Arteaga, O.J. Bernal-
Ramírez, S.J. Rodríguez
Published on: (August - September 2015) Vol.
39. Issue 6.pages 359-372
Published in: Medicina Intensiva
64. Prone position ventilation has been shown to
improve oxygenation and ventilatory
mechanics in patients with acute respiratory
distress syndrome. We evaluated whether
prone ventilation reduces the risk of mortality
in adult patients with acute respiratory distress
syndrome versus supine ventilation.
65. A meta-analysis of randomized controlled
trials comparing patients in supine versus
prone position was performed. A search
was conducted of the Pubmed, Embase,
Cochrane Library, and LILACS
databases. Mortality, hospital length of
stay, days of mechanical ventilation and
adverse effects were evaluated
66. Seven randomized controlled trials (2119
patients) were included in the analysis. The
prone position showed a nonsignificant
tendency to reduce mortality (OR: 0.76;
95%CI: 0.54–1.06; p=0.11, I2 63%). When
stratified by subgroups, a significant decrease
was seen in the risk of mortality in patients
ventilated with low tidal volume (OR: 0.58;
95%CI: 0.38–0.87; p=0.009, I2 33
67. %), prolonged pronation (OR: 0.6; 95%CI: 0.43–
0.83; p=0.002, I2 27%), start within the first 48h of
disease evolution (OR 0.49; 95%CI 0.35–
0.68; p=0.0001, I2 0%) and severe hypoxemia (OR:
0.51: 95%CI: 0.36–1.25; p=0.0001, I2 0%). Adverse
effects associated with pronation were the
development of pressure ulcers and endotracheal
tube obstruction.
68. The prone position offers clinical benefits such as
improved oxygenation, by optimizing lung
recruitment and the ventilation–perfusion ratio, and
probably also prevents and reduces ventilator-
associated lung injury by homogenizing the stress
and strain upon the lung parenchyma, resulting in a
decrease in mortality risk.
69. Based on the results obtained, the prone
position can be recommended in patients
with severe hypoxemia(PaO2/FiO2<100),
associated to a low tidal volume (<8ml/kg
ideal weight), during a period of over 16h
a day, and starting early during the course
of the disease (<48h). These consequently
would be the indications and associated
strategies to be included in pronation
protocols.
70. ARDS is a life threatening lung condition
that prevents enough oxygen from getting
into blood. It is characterized by
accumulation of excessive fluid in the
lungs with resulting hypoxemia.
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