Acute Respiratory Distress Syndrome (ARDS) Notes Flashcards Preview

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1

Acute Respiratory Distress Syndrome (ARDS) definition

Sudden and progressive form of ARF
Alveolar-capillary membrane becomes damaged and more permeable to intravascular fluid.

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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

3

Factors that determine course of ARDS

initial injury extent
severity of course morbidities
pulmonary complications

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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.

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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.

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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.

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cistracarium (Nimbex)

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.

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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.

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Cardiac Complications Associated with ARDS

Decreased CO
Dysrhythmias

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CNS and Psychologic Complications Associated with ARDS

Delirium
PTSD

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GI Complications Associated with ARDS

Hypermetabolic state, increase nutrition requirements
Paralytic ileus
Pneumoperitoneum (abnormal presence of air)
Stress ulceration and hemorrhage

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Hematologic Complications Associated with ARDS

Anemia
DIC
Thrombocytopenia
VTE

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Infection Complications Associated with ARDS

Catheter- related infection
Sepsis

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Renal Complications Associated with ARDS

AKI

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Respiratory Complications Associated with ARDS

PE
Pulmonary fibrosis
Ventilator associated: volutrauma or barotrauma
VAP

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What vital organs are affected by ARDS?

Lungs
Kidneys
Liver
Heart

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Main cause of death in ARDS:

MODS

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Long-term complications with ARDS

Abnormal lung function where Pt reports extreme tiredness, chest pain, SOB after minimal activity, persistent dyspnea post-ARDS.

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How to tx VAP?

Elevate HOB 30-45 degrees, strict infection control, and frequent oral care.

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Barotrauma definition

Fragile alveoli are overdistended with excess pressure during mechanical ventilation.

21

What should you monitor or consider when pt develops AKI with ARDS?

Monitor I&O, daily creatinine and urea levels.
Allow for dialysis therapy and Continuos renal replacement therapy (CRRT).