ARDS Flashcards
RF for ARDS
Critical illness
Smoking
Etoh use chronic
Long term exposure to air pollutants
Clin F of ARDS
Progressive SOB
Tachypnea
Fever
Cough
Pleurtic CP
AMS secondary to hypoxi
DDX ARDS
COVID 19
Acute HF
Bilateral pneumonia
Diffuse alveolar hemorrhage
Acute eosinophillic pneumonia
Hypersensitivity pneumonitis
Simple diagnostic criteria of ARDS
Abnormal XR
Resp failure <1week after trigger
Decreased Pa02/FiO2
Should r/o CHF and fluid overload as causes
Causes of ARDS
Extrapulmonary - PECANS
Pancreatitis
Excessive transfusion
Cocaine
Aspirin and salicyclate toxicity
Narcotics
Shock - non cardiogenic
Pulmonary - SALTED
Severe pneumonia
Aspiration
Lung contusion
Toxin inhalation
Embolism - pulmonary, fat, amniotic
Drowning
Mng of ARDS
Initial - oxygen and ventilation
Prone positioning for at least 12 hours per day
Fluid balance at slightly negative or euvolemic unless shocked
Tx infections
Ongoing - supportive: DVT ppx, BGL control, ppx for stress ulcers, maintain MAP >60, transfuse packed RBC if Hb <70
- Rescue therapies if refractory hypoxemia: ECMO, MN paralysis with inhaled nitric oxide, prostacyclin
Cx of ARDS
Persistent SOB
Ventilator associated pneumonia
Abnormal PFTS
Decreased QOL
PTX
Multiple organ failure
Death
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X-ray chest (AP portable view; semierect position) of a patient whose respiratory status acutely deteriorated 48 hrs after hospitalization for blastomycosis pneumonia
Poorly marginated opacities are present throughout both lungs, with relative sparing of the lung bases along the diaphragms (examples indicated by arrowheads). Features common in cardiogenic edema, such as septal thickening, perihilar and gravitational dependence, cardiac silhouette enlargement, and vascular pedicle widening) are notably lacking. Nasogastric (red overlay) and endotracheal tubes (green overlay) are present.
The radiographic appearance is consistent with noncardiogenic edema and compatible with the clinical diagnosis of ARDS.
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X-ray chest (AP view) of a patient with adult respiratory distress syndrome (ARDS)
Confluent and multifocal airspace opacities (examples indicated by green overlay) predominate in the lower zones of the lungs. Air bronchograms (examples indicated by red lines) are visible in some locations. There are no Kerley lines or pleural effusions. The cardiac silhouette size is normal. An endotracheal tube (arrow) is present.
ARDS and other causes of noncardiogenic edema can produce extensive airspace opacification, as can cardiogenic edema, diffuse pneumonia, diffuse alveolar hemorrhage, pneumonic-type adenocarcinoma, and pulmonary alveolar proteinosis. Radiography alone cannot establish a diagnosis of ARDS.
