Flashcards in Acute Respiratory Distress Syndrome (ARDS) Notes Deck (21)
Acute Respiratory Distress Syndrome (ARDS) definition
Sudden and progressive form of ARF
Alveolar-capillary membrane becomes damaged and more permeable to intravascular fluid.
3 Stages of ARDS and clinical progression
Injury or exudative phase - 24-72 hrs after initial insult , lasts up to 7 days. PE resolves, complete recovery can occur within a week or so.
Reparative or proliferative phase - 1-2 wks after lung injury.
Fibrotic or chronic phase - 2-3 wks after initial lung injury, lung can be completely remodeled. poor prognosis with several weeks of long-term mechanical ventilation
Factors that determine course of ARDS
initial injury extent
severity of course morbidities
C/M of Early stages of ARDS:
initial injury until 48 hours later.
Mild dyspnea, tachypnea, cough and restlessness.
Normal to scattered crackles.
ABGs show mild hypoxemia and respiratory alkalosis.
C/M as ARDS progresses:
Respiratory distress becomes evident as WOB increases.
Tachypnea, intercostal and suprasternal retractions may be present.
Tachycardia, diaphoresis, LOC changes, cyanosis, pallor
Chest x-ray: diffuse and extensive bilateral interstitial and alveolar infiltrates.
Refractory hypoxemia - classical hallmark of ARDS.
Classic Interpretations of ARDS
Profound dyspnea, hypoxemia, increased WOB, and respiratory distress.
Require endotracheal intubation and PPV.
Chest x-ray: Whiteout lung, lots of infiltrates.
Severe hypoxemia, hypercapnia, metabolic acidosis and organ dysfunction are present.
Neuromuscular blocking agent (NMBA)
Relaxes skeletal muscles and promote synchrony with mechanical ventilation
Always give with concurrent analgesia and sedation to pts.
Use for shortest duration at lowest dose possible.
Monitor levels of sedation in pts.
How do you monitor levels of sedation in pts. ?
Monitor clinical assessment
Respiratory rate and whether pt is taking breaths above set rate on ventilator.
Cardiac Complications Associated with ARDS
CNS and Psychologic Complications Associated with ARDS
GI Complications Associated with ARDS
Hypermetabolic state, increase nutrition requirements
Pneumoperitoneum (abnormal presence of air)
Stress ulceration and hemorrhage
Hematologic Complications Associated with ARDS
Infection Complications Associated with ARDS
Catheter- related infection
Renal Complications Associated with ARDS
Respiratory Complications Associated with ARDS
Ventilator associated: volutrauma or barotrauma
What vital organs are affected by ARDS?
Main cause of death in ARDS:
Long-term complications with ARDS
Abnormal lung function where Pt reports extreme tiredness, chest pain, SOB after minimal activity, persistent dyspnea post-ARDS.
How to tx VAP?
Elevate HOB 30-45 degrees, strict infection control, and frequent oral care.
Fragile alveoli are overdistended with excess pressure during mechanical ventilation.