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Acute Respiratory Distress Syndrome

Acute Respiratory Distress Syndrome. Taylor Wofford, MD UNC Internal Medicine July 14, 2009. Over the years…. Shock lung Wet lung DaNang lung Stiff lung Pump lung … Actut Respiratory Distress Syndrome. ARDS. PaO2/FiO2 <200 Acute onset Bilateral infiltrates c/w pulmonary edema

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Acute Respiratory Distress Syndrome

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  1. Acute Respiratory Distress Syndrome Taylor Wofford, MD UNC Internal Medicine July 14, 2009

  2. Over the years… • Shock lung • Wet lung • DaNang lung • Stiff lung • Pump lung • … • Actut Respiratory Distress Syndrome

  3. ARDS • PaO2/FiO2 <200 • Acute onset • Bilateral infiltrates c/w pulmonary edema • No clinical evidence for elevated LA pressure (1994 American-European Consensus Conference Committee)

  4. Pathophysiology ARDS Normal lung

  5. Sepsis Aspiration Pneumonia Severe trauma/burns Massive blood transfusion TRALI Relief of airway obstruction Lung and BMT Drug overdose Pancreatitis Near drowning Smoke inhalation Cardiopulmonary bypass Venous air embolism Neurogenic pulmonary edema Causes of ARDS

  6. Evaluation of ARDS • ABG • CXR • Consider bronchoscopy • Infectious workup

  7. Management of ARDS • Mechanical ventilation • Vt <6 mL/kg • PIP goal <40 cmH20 • Permissive hypercapnea • High PEEP • Pressure mode > volume mode • FiO2 as low as possible • ARDS Network Study

  8. Notable options • Airway Pressure Release Ventilation (APRV) = BiVent • NO • Prone positioning • High Frequency Oscillation • Recruitment maneuvers

  9. Outcomes of ARDS • 10-15% of ICU admissions • 190,600 cases in US per year • Approximately 41% mortality

  10. Bibliography • Evans TW. Respiratory Management in Critical Care. BMJ, 2004. • Fishman, AP. Shock lung: A distinict nonentity. Circulation 1973;47;921-923. • Green GB et al. The Washington Manual of Medical Therpeutics, 31st ed. Philadelphia: Lippincott Williams & Wilkins, 2004. • Husain AN. Pulmonary Pathology. www.meddean.luc.edu. • Siegel, MD. Acute respiratory distress syndrome: Pathophysiology; clinical manifestations; prognosis; and outcome. UpToDate.com, 2009.

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