ARDS:

Damage to the alveolar epithelium and capillary epithelium that allows the alveolar space to become flooded with edema of high protein contents(non cardiogenic)

Direct Lung Injury:

Aspiration of gastric contents Diffuse pulmonary infections (bacterial, viral, fungal) Pulmonary contusion Near drowning Inhalation injury Reperfusion pulmonary edema after lung transplant Radiation

Indirect lung injury:

Sepsis Severe trauma w/ shock hypoperfusion Acute pancreatitis Severe burns TRALI (Transfusion related acute lung injury) Cardiopulmonary bypass Anaphylaxis Lymph reticular malignancy

Insult (direct or indirect)

Activation of inflammatory cells & mediators Damage to alveolar capillary membrane

Increased permeability of alveolar capillary membrane Influx of protein rich edema fluid and inflammatory cells into air spaces Dysfunction of surfactant

Exudative (acute) phase (0- 4 days)

Proliferative phase (4- 8 days) Fibrotic phase ( >8 days) Recovery

Decreased ventilation

Impaired diffusion
Reduced perfusion

Precipitating insult is usually evident Early (24 48hrs) - cough, breathlessness, fatigue

Late (after 48hrs) - due to worsening hypoxemia - agitation, anxiety, confusion

Dyspnoea Tachypnoea Tachycardia Restlessness Cyanosis even with supplemental oxygen

Chest x-ray & CT thorax: - bilateral diffuse alveolar infiltrates more on the peripheral lung fields. - R/O Cardiogenic edema if there is * cardiomegaly * pulmonary artery dilatation * bats wing perihilar distribution * responding to diuretics

ARDS

CARDIOGENIC PULMONARY EDEMA

Arterial blood gas analysis: - PaO2 range 55 60 mm of Hg - Initially respiratory alkalosis later mixed acidosis Routine CBC, urea, creatinine, Na, K Echocardiogram to R/O Cardiogenic cause. PAWP < 18mm of Hg ALI / ARDS Bronchoscopy

Advanced age Male sex Extra pulmonary organ dysfunction Sepsis HIV Alcoholism Active malignancy Organ transplantation

 POST.OP

Good Analgesia O2 Therapy Nebulization Chest Physiotherapy Early Mobilization Proper Antibiotics

TREATMENT OF CAUSE e.g. antibiotics for pneumonia

2 3

SUPPORTIVE THERAPY (5Ps) Perfusion, Position, Protective lung ventilation, Protocol weaning, Preventing complications PHARMACOLOGICAL TREATMENT Steroids, vasodilators, surfactant, anti inflammatory

Acceptabl PT/Monitor Intubate e R/R 12--25 25--35 >35 VC(ml/kg) 70--30 30--15 <15 PaO2 10075 air <65 on mask O2 PaCO2 35--45 45--60 >60

TURNING PATIENT PRONE ON VOLLMAN PRONE POSITIONER

PATIENT LYING PRONE ON VOLLMAN PRONE POSITIONER

LATERAL ROTATION THERAPY BED

ACUTE RESPIRATORY FAILURE VENTILATOR ASSO PNEUMONIA VENTILATOR ASSO LUNG INJURY (VALI) DVT AND PULMONARY EMBOLISM PRESSURE SORES

REDUCED EXERCISE CAPACITY DECREASED QUALITY OF LIFE POST TRAUMATIC STRESS DISORDER (depression, anxiety, decreased memory & concentration) RARELY ACQUIRED CYSTIC LUNG DISEASE MAY DEVELOP