logging in or signing up ARDS LECTURE drrjkpulmo Download Post to : URL : Related Presentations : Share Add to Flag Embed Email Send to Blogs and Networks Add to Channel Uploaded from authorPOINT lite Insert YouTube videos in PowerPont slides with aS Desktop Copy embed code: (To copy code, click on the text box) Embed: URL: Thumbnail: WordPress Embed Customize Embed The presentation is successfully added In Your Favorites. Views: 3115 Category: Science & Tech.. License: All Rights Reserved Like it (3) Dislike it (0) Added: September 13, 2010 This Presentation is Public Favorites: 2 Presentation Description No description available. Comments Posting comment... Premium member Presentation Transcript ACUTE RESPIRATORY DISTRESS SYNDROME : ACUTE RESPIRATORY DISTRESS SYNDROME DR. JAYAKUMAR. R. M.D., ASST. PROFESSOR, DEPT. OF PULMONARY MEDICINE, CHETTINAD HOSPITAL & RESEARCH INSTITUTE ACUTE RESPIRATORY DISTRESS SYNDROME : ACUTE RESPIRATORY DISTRESS SYNDROME Synonyms: Non-Cardiogenic pulmonary edema Adult hyaline membrane disease Capillary leak syndrome Stiff lung syndrome Shock lung DEFINITION : DEFINITION ACUTE LUNG INJURY (ALI): A syndrome of inflammation and increased permeability that is associated with a constellation of clinical, radiologic, and physiologic abnormalities that cannot be explained by, but may co-exist with, left atrial or pulmonary hypertension. ARDS: Severe form of ALI CRITERIA FOR ALI & ARDS : CRITERIA FOR ALI & ARDS ARDS causes : ARDS causes Direct Lung Injury: Aspiration of gastric contents Diffuse pulmonary infections (bacterial, viral, fungal) Pulmonary contusion Near drowning Inhalation injury Reperfusion pulmonary edema after lung transplant Radiation ARDS causes : ARDS causes Indirect lung injury: Sepsis Severe trauma w/ shock hypoperfusion Acute pancreatitis Severe burns TRALI (Transfusion related acute lung injury) Cardiopulmonary bypass Anaphylaxis Lymph reticular malignancy ARDS - PATHOGENESIS : ARDS - PATHOGENESIS Insult (direct or indirect) Activation of inflammatory cells & mediators Damage to alveolar capillary membrane Increased permeability of alveolar capillary membrane Influx of protein rich edema fluid and inflammatory cells into air spaces Dysfunction of surfactant PATHOLOGICAL STAGES OF ARDS : PATHOLOGICAL STAGES OF ARDS Exudative (acute) phase (0- 4 days) Proliferative phase (4- 8 days) Fibrotic phase ( >8 days) Recovery PHYSIOLOGICAL ABNORMALITIES : PHYSIOLOGICAL ABNORMALITIES Decreased ventilation Impaired diffusion Reduced perfusion CLINICAL FEATURES – symptoms : CLINICAL FEATURES – symptoms Precipitating insult is usually evident Early (24 – 48hrs) - cough, breathlessness, fatigue Late (after 48hrs) - due to worsening hypoxemia - agitation, anxiety, confusion CLINICAL FEATURES – signs : CLINICAL FEATURES – signs Dyspnoea Tachypnoea Tachycardia Restlessness Cyanosis even with supplemental oxygen ( refractory hypoxemia) Differential diagnosis : Differential diagnosis Cardiogenic pulmonary edema Diffuse alveolar hemorrhage Acute pulmonary embolism Acute eosinophilic pneumonia Hypersensitivity pneumonitis Pulmonary alveolar protienosis Sarcoidosis Leukemic infiltration Drug induced pulmonary edema Investigations : Investigations Chest x-ray & CT thorax: bilateral diffuse alveolar infiltrates more on the peripheral lung fields. R/O Cardiogenic edema if there is * cardiomegaly * pulmonary artery dilatation * bat’s wing perihilar distribution * responding to diuretics Slide 16: Ards Slide 17: Cardiogenic pulmonary edema Slide 18: NEONATAL RESPIRATORY DISTRESS SYNDROME INVESTIGATIONS : INVESTIGATIONS Arterial blood gas analysis: PaO2 range 55 – 60 mm of Hg Initially respiratory alkalosis later mixed acidosis Routine CBC, urea, creatinine, Na, K Echocardiogram to R/O Cardiogenic cause. PAWP < 18mm of Hg ALI / ARDS Bronchoscopy ( CCF,DAH,AEP) ASSESSMENT OF SEVERITY : ASSESSMENT OF SEVERITY Murray lung injury score: - Chest x-ray - Hypoxemia - PEEP - Compliance Score 0 no lung injury o.1 – 2.5 mild to moderate lung injury > 2.5 severe lung injury POOR PROGNOSIS FACTORS : POOR PROGNOSIS FACTORS Advanced age Male sex Extra pulmonary organ dysfunction Sepsis HIV Alcoholism Active malignancy Organ transplantation Treatment of ALI/ARDS : Treatment of ALI/ARDS Complications (ACUTE) : Complications (ACUTE) ACUTE RESPIRATORY FAILURE VENTILATOR ASSO PNEUMONIA VENTILATOR ASSO LUNG INJURY (VALI) DVT AND PULMONARY EMBOLISM PRESSURE SORES Complications (CHRONIC) : Complications (CHRONIC) REDUCED EXERCISE CAPACITY DECREASED QUALITY OF LIFE POST TRAUMATIC STRESS DISORDER (depression, anxiety, decreased memory & concentration) Rarely acquired cystic lung disease may develop Slide 26: Thank you You do not have the permission to view this presentation. In order to view it, please contact the author of the presentation.
ARDS LECTURE drrjkpulmo Download Post to : URL : Related Presentations : Share Add to Flag Embed Email Send to Blogs and Networks Add to Channel Uploaded from authorPOINT lite Insert YouTube videos in PowerPont slides with aS Desktop Copy embed code: (To copy code, click on the text box) Embed: URL: Thumbnail: WordPress Embed Customize Embed The presentation is successfully added In Your Favorites. Views: 3115 Category: Science & Tech.. License: All Rights Reserved Like it (3) Dislike it (0) Added: September 13, 2010 This Presentation is Public Favorites: 2 Presentation Description No description available. Comments Posting comment... Premium member Presentation Transcript ACUTE RESPIRATORY DISTRESS SYNDROME : ACUTE RESPIRATORY DISTRESS SYNDROME DR. JAYAKUMAR. R. M.D., ASST. PROFESSOR, DEPT. OF PULMONARY MEDICINE, CHETTINAD HOSPITAL & RESEARCH INSTITUTE ACUTE RESPIRATORY DISTRESS SYNDROME : ACUTE RESPIRATORY DISTRESS SYNDROME Synonyms: Non-Cardiogenic pulmonary edema Adult hyaline membrane disease Capillary leak syndrome Stiff lung syndrome Shock lung DEFINITION : DEFINITION ACUTE LUNG INJURY (ALI): A syndrome of inflammation and increased permeability that is associated with a constellation of clinical, radiologic, and physiologic abnormalities that cannot be explained by, but may co-exist with, left atrial or pulmonary hypertension. ARDS: Severe form of ALI CRITERIA FOR ALI & ARDS : CRITERIA FOR ALI & ARDS ARDS causes : ARDS causes Direct Lung Injury: Aspiration of gastric contents Diffuse pulmonary infections (bacterial, viral, fungal) Pulmonary contusion Near drowning Inhalation injury Reperfusion pulmonary edema after lung transplant Radiation ARDS causes : ARDS causes Indirect lung injury: Sepsis Severe trauma w/ shock hypoperfusion Acute pancreatitis Severe burns TRALI (Transfusion related acute lung injury) Cardiopulmonary bypass Anaphylaxis Lymph reticular malignancy ARDS - PATHOGENESIS : ARDS - PATHOGENESIS Insult (direct or indirect) Activation of inflammatory cells & mediators Damage to alveolar capillary membrane Increased permeability of alveolar capillary membrane Influx of protein rich edema fluid and inflammatory cells into air spaces Dysfunction of surfactant PATHOLOGICAL STAGES OF ARDS : PATHOLOGICAL STAGES OF ARDS Exudative (acute) phase (0- 4 days) Proliferative phase (4- 8 days) Fibrotic phase ( >8 days) Recovery PHYSIOLOGICAL ABNORMALITIES : PHYSIOLOGICAL ABNORMALITIES Decreased ventilation Impaired diffusion Reduced perfusion CLINICAL FEATURES – symptoms : CLINICAL FEATURES – symptoms Precipitating insult is usually evident Early (24 – 48hrs) - cough, breathlessness, fatigue Late (after 48hrs) - due to worsening hypoxemia - agitation, anxiety, confusion CLINICAL FEATURES – signs : CLINICAL FEATURES – signs Dyspnoea Tachypnoea Tachycardia Restlessness Cyanosis even with supplemental oxygen ( refractory hypoxemia) Differential diagnosis : Differential diagnosis Cardiogenic pulmonary edema Diffuse alveolar hemorrhage Acute pulmonary embolism Acute eosinophilic pneumonia Hypersensitivity pneumonitis Pulmonary alveolar protienosis Sarcoidosis Leukemic infiltration Drug induced pulmonary edema Investigations : Investigations Chest x-ray & CT thorax: bilateral diffuse alveolar infiltrates more on the peripheral lung fields. R/O Cardiogenic edema if there is * cardiomegaly * pulmonary artery dilatation * bat’s wing perihilar distribution * responding to diuretics Slide 16: Ards Slide 17: Cardiogenic pulmonary edema Slide 18: NEONATAL RESPIRATORY DISTRESS SYNDROME INVESTIGATIONS : INVESTIGATIONS Arterial blood gas analysis: PaO2 range 55 – 60 mm of Hg Initially respiratory alkalosis later mixed acidosis Routine CBC, urea, creatinine, Na, K Echocardiogram to R/O Cardiogenic cause. PAWP < 18mm of Hg ALI / ARDS Bronchoscopy ( CCF,DAH,AEP) ASSESSMENT OF SEVERITY : ASSESSMENT OF SEVERITY Murray lung injury score: - Chest x-ray - Hypoxemia - PEEP - Compliance Score 0 no lung injury o.1 – 2.5 mild to moderate lung injury > 2.5 severe lung injury POOR PROGNOSIS FACTORS : POOR PROGNOSIS FACTORS Advanced age Male sex Extra pulmonary organ dysfunction Sepsis HIV Alcoholism Active malignancy Organ transplantation Treatment of ALI/ARDS : Treatment of ALI/ARDS Complications (ACUTE) : Complications (ACUTE) ACUTE RESPIRATORY FAILURE VENTILATOR ASSO PNEUMONIA VENTILATOR ASSO LUNG INJURY (VALI) DVT AND PULMONARY EMBOLISM PRESSURE SORES Complications (CHRONIC) : Complications (CHRONIC) REDUCED EXERCISE CAPACITY DECREASED QUALITY OF LIFE POST TRAUMATIC STRESS DISORDER (depression, anxiety, decreased memory & concentration) Rarely acquired cystic lung disease may develop Slide 26: Thank you