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


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


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


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

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