ARDS

Views:
 
Category: Entertainment
     
 

Presentation Description

No description available.

Comments

Presentation Transcript

ARDS:

ARDS

ARDS:

ARDS Clinical syndrome of Severe dyspnoea of rapid onset Hypoxemia Diffuse pulmonary infiltrates leading to Respiratory Failure

Etiology:

Etiology Caused by diffuse lung injury from many medical / surgical disorders More the risk factors higher the chance of developing ARDS

Etiology:

Etiology Direct Lung Injury Pneumonia Aspiration of gastric contents Pulmonary Contusion Near drowning Toxic inhalation injury Indirect Lung Injury Sepsis Severe trauma Multiple bone # Flail chest Head trauma Burns Multiple transfusions Drug overdose (Aspirin / Opiates) Pancreatitis Post Cardiopulmonary bypass Obstretic crises (Amniotic fluid embolism / Eclampsia) Anaphylaxis

Pathophysiology:

Pathophysiology Inflammatory process Neutrophil sequestration in pulmonary capillaries Increased capillary permeability Protein rich pulmonary oedema with hyaline membrane formation Damage to type 2 pneumocytes leading to surfactant depletion Alveolar collapse and reduction in lung compliance

3 Phases:

3 Phases Exudative – 1 st 7 days Proliferative – 7 to 21 days Fibrotic phase – 3 to 4 weeks after initial pulmonary injury

Diagnostic criteria:

Diagnostic criteria Oxygenation – PaO2 / FiO2  200 mmHg (ALI  300 mmHg) Onset – acute X-Ray – Bilateral Alveolar / Interstitial Infiltrates Absence of  Left Atrial Pressure PCWP  18 mmHg

Investigations:

Investigations ABG – Hypoxemia Hypercapnia (secondary to  in pulmonary dead space) X-Ray – alveolar and / or interstitial infiltrates involving atleast ¾ of lung fields Underlying illness

Differential Diagnosis:

Differential Diagnosis Cardiogenic Pulmonary Oedema Diffuse Pneumonia Alveolar Hemorrhage

Treatment:

Treatment Recognition and treatment of underlying medical / surgical disorders Mechanical ventilation Low tidal volume PEEP Inverse ratio ventilation ( I : E > 1 : 1) Prone positioning (Proning) Fluid Management Maintaining a normal / low left Atrial Pressure

Treatment:

Treatment Glucocorticoids Improved outcome – 7 to 10 days after diagnosis (Fibroproliferative stage) Recommended dose Methylprednisolone 2 to 3 mg/Kg body weight  after 7 days and after gas exchange improves

Treatment:

Treatment Prophylaxis against venous thromboembolism / GI bleed / CV catheter infection Prevention and treatment of Nosocomial infections Adequate nutrition

Prognosis:

Prognosis 40 to 65% mortality Poor prognosis associated with Elderly age Pre-existing organ dysfunction from chronic medical illness ARDS secondary to direct lung injury > Indirect lung injury

Non Cardiogenic Pulmonary Oedema:

Non Cardiogenic Pulmonary Oedema ARDS causes Rapid evacuation of large pneumothorax Lymphatic blockage secondary to fibrotic / inflammatory diseases / Lymphangitic carcinomatosis

Slide 19:

Thank You

authorStream Live Help