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Damage to the alveolar epithelium and capillary epithelium that allows the alveolar space to become flooded with edema of high protein contents(non cardiogenic)
Aspiration of gastric contents Diffuse pulmonary infections (bacterial, viral, fungal) Pulmonary contusion Near drowning Inhalation injury Reperfusion pulmonary edema after lung transplant Radiation
Sepsis Severe trauma w/ shock hypoperfusion Acute pancreatitis Severe burns TRALI (Transfusion related acute lung injury) Cardiopulmonary bypass Anaphylaxis Lymph reticular malignancy
Decreased ventilation
Impaired diffusion
Reduced perfusion
Precipitating insult is usually evident Early (24 48hrs) - cough, breathlessness, fatigue
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
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
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
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