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FUTURE MANAGEMENT
IN ARDS
ZUSWAYUDHA SAMSU
STAF ANESTESI DAN PERAWATAN INTENSIF PASCA BEDAH
RS JANTUNG HARAPAN KITA
ACUTE RESPIRATORY FAILURE
Pulmonary Dysfunction HYPERCAPNIC
HYPOXIC
RESPIRATORY FAILURE
RESPIRATORY FAILURE
AaDO2 , TLc , VA COPD, BRONCHIOLITIS
PNEUMONIA, ARDS
OBLITERANCE
LUNG FIBROSIS
Hypoxemia Hypercapnia
ARDS
• Acute Lung injury with ratio of 200
Ranieri VM, Thompson BT, Rubenfield G et al, The ARDS Definition Task Force
JAMA, June 20, 2012, Vol 307-23
“HALLMARK” OF ARDS
Diffuse Alveolar
Damage
ETIOLOGY OF ARDS
TREATMENT • ETIOLOGIC
OF ARDS • SYMPTOMATIC
HIGH RISK PATIENTS TO DEVELOP
ARDS, WHO ARE THEY?
ARF
ARDS
PATIENTS ARF PATIETNS WITH
PATIENTS
WITHOUT ARDS
DIAGNOSED
ARDS
ECMO CRITERIA
CONTINUE
P/F <80 NO PREVIOUS
MANAGEMENT
YES
INITIATE ECMO
EVALUATION
To replace
pulmonary function.
To allow healing of
the Lung
PHERIPERAL VA ECMO IS NOT
INDICATED FOR ARF - WHY?
• UK 2001-2006
• ECMO provided only at the Glenfiled Hospital, Leicester
• Entry Criteria
• Adult patients (18-65 years)
• Severe but potentially reversible ARDS
• Murray score >3.0 or
• Uncompensated Hypercapnia : pH <7.20
ECCO2R
COMPLICATIONS