2. Guru Brahma Gurur Vishnu
Guru Devo Maheshwaraha
Guru Saakshat Para Brahma
Tasmai Sree Gurave Namaha
Meaning:Guru is verily the representative of Brahma, Vishnu and
Shiva. He creates, sustains knowledge and destroys the weeds of
ignorance. I salute such a Guru.
4. STAGES
Acute, exudative
phase
◦ rapid onset of respiratory
failure after trigger
◦ diffuse alveolar damage
with inflammatory cell
infiltration
◦ hyaline membrane
formation
◦ capillary injury
◦ protein-rich edema fluid in
alveoli
◦ disruption of alveolar
epithelium
Expansion of
interstitium with
macrophages
and
inflammation
Hyaline
Membra
nes
Alveolar
Filling
5. Proliferative phase:
◦ persistent hypoxemia
◦ development of hypercarbia
◦ fibrosing alveolitis
◦ further decrease in pulmonary compliance
◦ pulmonary hypertension
Chronic phase / Recovery phase
◦ obliteration of alveolar and bronchiolar
spaces and pulmonary capillaries
◦ gradual resolution of hypoxemia
◦ improved lung compliance
◦ resolution of radiographic abnormalities
6. ARDS causes
Direct Lung Injury:
a) PNA and aspiration of gastric contents
or other causes of chemical
pneumonitis
b) pulmonary contusion, penetrating lung
injury
c) fat emboli
d) near drowning
e) inhalation injury
f) reperfusion pulm edema after lung
transplant
7. ARDS causes
Indirect lung injury
a) sepsis
b) severe trauma w/ shock
hypoperfusion
c) drug over dose
d) cardiopulmonary bypass
e) acute pancreatitis
f) transfusion of multp blood products
8.
9. WHAT IS A DEFINITION
A definition is a thorough description of
the meaning of a lexical unit
10. WHY DEFINITION
FACILITATES RESEARCH
PATHOGENESIS AMPLIFIED AND
NOTIFIED
COMPARISION OF VARIOUS CLINICAL
TRIALS
EARLY INSTITUTION OF
STANDARDISED CARE
OUTCOME PROGNOSTICATION
MEASURE THE IMPACT (ECONOMIC,
SOCIAL) ETC
11. DEFINITION OF ALI/ARDS
AMERICAN-EUROPEAN CONSENSUS
CONFERENCE 1994
ALI CRITERIA
Timing: acute onset
Oxygenation: PaO₂/FIO₂≤ 300 MM Hg
(regardless of peep)
Chest Radiograph: bilateral infiltrates
seen on frontal chest radiograph
Pulmonary artery wedge:≤ 18 mm Hg
when measured or no clinical evidence
of left atrial hypertension
12. DEFINITION OF ALI/ARDS
ARDS CRITERIA
Timing: acute onset
Oxygenation: PaO₂/FIO₂≤ 200 MM
Hg (regardless of peep)
Chest Radiograph: bilateral infiltrates
seen on frontal chest radiograph
Pulmonary artery wedge:≤ 18 mm Hg
when measured or no clinical
evidence of left atrial hypertension
13.
14.
15. MURRAY LIS
No Lung Injury Score 0
Mild To Moderate Lung Injury Score 1-
2.5
Severe Lung Injury > 2.5
16. DELPHI CONSENSUS
DEFINITION
PEEP (>10) PaO₂/FIO₂≤ 200 MM Hg
RADIOGRAPHIC CRITERIA > 2
QUADRANTS
QUANTITATIVE PULMONARY
COMPLIANCE ABNORMALITIES
OR
PREDISPOSING CONDITION
NON CARDIOGENIC PULMONARY
OEDEMA CHARACTERISATION
EITHER BY PAC OR TTE
17. OXYGENATION INDEX
OI = MAP × FIO₂ × PaO ₂ /100
OI > 30 HAS BEEN ASSOCIATED
WITH POOR OUTCOME
19. RELIABILITY AND VALIDITY
RELIABILITY INTEROBSERVER
INTRAOBSERVER
VALIDITY FACE
CONTENT
CRITERION
CONCURRENT
PREDICTIVE
CONSTRUCT
CONVERGENT
DISCRIMINANT
20. Face Validity Do the diagnostic criteria
appear to describe the disease entity in
question
Criterion Validity Do the diagnostic criteria
correlate with gold standard
Predictive Validity Does this predict a
certain outcome or response to therapy
21. HYPOXEMIA
VARIES WITH FIO₂
EFFECT OF PEEP
CONFOUNDING FACTORS
ATELECTASIS
LOW
C.O
SHUNT
VENTILATORY SETTINGS
TIME PERIOD
26. HYPOXEMIA PaO₂/FIO₂≤ 201-
300 WITH
PEEP/CPAP≥5
PaO₂/FIO₂≤ 200
WITH
PEEP/CPAP≥5
PaO₂/FIO₂≤ 100
PEEP/CPAP≥10
TIMIMING ACUTE ONSET WITHIN 1 WEEK OF A KNOWN CLINICAL
INSULT OR NEW/WORSENING RESPIRATORY SYMPTOMS
Mild Moderate Severe
ORIGIN OF
OEDEMA
RESPIRATORY FAILURE NOT EXPLAINED BY CARIAC
FAILURE OR FLUID OVERLOAD
RADIOLOGIC
ABNORMALITIES
BILATERAL
OPACITIES
BILATERAL
OPACITIES
OPACITIES
INVOLVING AT
LEAST THREE
QUADRANTS
ADDITIONAL
PHYSIOLOGIC
DERANGEMENTS
N/A N/A
VEcorr>10L/MIN
OR
Crs ≤ 40 ml/cm H₂О
ARDS
27. RECURITABLE LUNGS
30-40 cm H₂O AIR WAY PRESSURE FOR
30-40 SECS
PEEP BY 10 cm H₂O TO A MAXIMUM OF
20 cm H₂O
POTENTIAL HIGH POTENTIAL
LOW
SpO₂> 5% MARGINAL
EFFECT
PaCO₂ PaCO₂
Compliance
Compliance
28. RESCUE THERAPIES
High peep levels
Lung recruitment maneuvers
High frequency ventilation
Airway pressure release ventilation
Prone positioning
Extracorporeal life support