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

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% )……

4. ARDS ::
CAUSES –
 DIRECT LUNG INJURY –Pneumonia, aspiration, inhalation injuries,
RTA,Near Drowning etc…….
 INDIRECT LUNG INJURY –Sepsis, massive blood transfusion etc….
STAGES –( By Severity pao2/ Fio2 ratio)
1.MILD ARDS (200-300mmhg)
2.MODERATE ARDS (100-200mmhg)
3.SEVERE ARDS (<100MMHG )

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 …

15. THANK YOU
ALL