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Syndrome
(ARDS)
Belal Alrajoub
Definition
There is no one or unified definition that is
used universally.
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Diagnostic Considerations
ARDS is the final pathway of a multi-factorial group of
insults.[1]
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4
Essential Diagnostic Tests and Procedures
Chest radiograph.
ABGs measurements.
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Berlin Definition of
ARDS
Fanelli, V., Vlachou, A., Ghannadian, S., Simonetti, U., Slutsky, A., Zhang,H. (2013). Acute 6
respiratory distress syndrome: New definition, current and future therapeutic
ARDS defined by the American European
Consensus Conference
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Physical examination
Clinically apparent respiratory failure
may ensue after several hours from
the initial insult. [1]
Some authors divided the PE findings
into 4 categories. [1]
1. Acute injury
2. Latent period
3. Acute respiratory failure
4. Severe abnormalities
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1. Acute injury
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2. Latent period
Lasts approximately 648 h after injury
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3. Acute respiratory failure
Decreased lung
compliance.
High-pitched crackles
heard throughout all the
lung fields.
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4.Severe abnormalities
Severe hypoxemia
unresponsive to therapy.
Increased intrapulmonary
shunting.
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Diagnostic criteria
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General Principles of ARDS
Management
Fluid Management High-frequency
Ventilation
Steroids
Extracorporeal Life
Support
Inhaled NO
Liquid Ventilation
Surfactant Replacement
Prone Positioning
Respiratory Support
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Respiratory Support
Initial
Goals and
managem
limits
ent
Initiate vent.
parameters
Md: A/C pressure
controlled Titrat
e
TV: Set TV to 8 ml/kg of TV by 1ml/kg @ int. of 2hr till
PBW 6ml/kg
RR: baseline min
volume 25 cm H2O < Pplat 30 cm
(not > 35 bpm) H2O
I flow rate: > pt.
Adjus
demand t pH : 7.30-7.45
(usually > 80L/min)
Special http://www.ardsnet.org/
considerations
Management Strategies
Recruitment Maneuvers and
High PEEP
C*
200
Prevents alveolar collapse [2], [3] 8
Increases V/Q areas [2]
Improves gas exchange [1]
Improve respiratory system compliance in some patients [2]
Risks
! CT
Circulatory depression & barotrauma [2] 2006
Alveolar fluid clearance [3]
There is extreme variability in the
percentage of potentially recruitable
lung areas. [4]
Risks
! RCT
2013
Pressure injury. [1]
Difficulty with humidification of inspired gas.HFOV
[1] had no significant
Hemodynamic deterioration.[3] effect on 30-days
Need for heavy sedation and mortality. [5]
neuromuscular blockade. [3]
SS:795
multicenter,
randomized
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Management Strategies
Fluid
Management
D*
200
Conservative management. 8
Extravascular lung water. [1]
duration of mechanical ventilation. [1]
prevents further decrements in arterial oxygenation and lung
compliance. * RCT
improves pulmonary mechanics. * 2006
No difference in 60-day
mortality.
SS:
Special Researchers supported1000
considerations conservative therapy. [6]
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Management Strategies
Surfactant
Replacement
D*
200
Surfactant replacement is associated with survival improvement
8
In neonatal ARDS. [1]
Phase III trial of protein Cbased surfactant showed improvement
in oxygenation without lowering mortality or the number of
ventilator days in adults. [1] RCT Sample size:
2011 1200.
Prospective RCT,
blinded, 161
center, 22
countries [11]
Recombinant protein Cbased surfactant has no
significant benefit in pt.s with direct sever lung
injury.
RCT[2]
2004