Adult Acute Respiratory Distress Syndrome

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Adult (Acute Respiratory Distress Syndrome

• Paramedic Program
• Chemeketa Community College

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What in the heck is ARDS?

• A fulminent form of respiratory failure
• Noncardiac pulmonary edema
• Acute lung inflammation
• Diffuse alveolar-capillary injury
• 200,000 cases per year
• Mortality 40-70
• Severe hypoxia

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• Intrapulmonary shunting
• Reduced lung compliance
• Irreversible parenchymal lung damage
• Usually healthy lungs before event
• More common in men

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A complication of injury or illness

• Trauma
• Direct pulmonary injury
• Multiple trauma

• Gram-negative sepsis
• Gastric aspiration
• Cardiopulmonary bypass surgery

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Complications, cont.

• Multiple blood transfusions
• Oxygen toxicity
• Toxic inhalation
• Pneumonia

• OD (tricyclics, heroin, methadone, barbiturates,
  salicylates)
• Infections
• Drowning (12-24 hours)

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Yes, but what happens?

• Increased capillary permeability wet congested
  lungs decreased perfusion capacity
• Decreased pulmonary compliance
• Requires higher airway pressure

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3 phases

• Exudative phase injury to endothelium and
  epithelium, inflammation, fluid exudation
• Fibroproliferative phase influx and
  proliferation of fibroblasts injury may begin to
  resolve or become persistant
• Fibrosis phase resolution of inflammation
  development of pulmonary fibrosis

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Diffuse Alveolar Damage
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The patient

• Onset w/in 72 hours
• Mild tachypnea may be only manifestation
• Labored breathing, tachypnea
• Cyanosis
• Moist skin
• Hyperventilation
• Scattered crackles/rales

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• Absent signs of volume overload
• 3rd heart sound
• JVD
• Agitation
• Lethargy
• Obtundation

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DDX

• CHF
• Pulmonary edema
• Aspiration pneumonia
• Bacterial pneumonia
• Immunocompromised pneumonia
• Viral pneumonia
• Smoke inhalation
• Cardogenic pulmonary edema

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Complications

• Respiratory failure
• Cardiac dysrhythmias
• Disseminated intravascular coagulation
• Barotrauma
• Congestive heart failure
• Renal failure
• Multiple organ failure

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Management

• Always high oxygen
• Sa02
• IV
• ET prn
• PEEP or CPAP
• Maintain Sa02 at 92-94
• Fluid replacement to maintain cardiac output

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Management, cont.

• Corticosteroids - controversial
• Diuretics
• Consider Dobutamine
• 2.5 mcg/kg/min titrate to effect

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Work up in the ED

• ABGs
• CXR
• Sputum collection

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Important to recognize

• Patients who have been resuscitated may have a
  period of relative stability followed by
  deterioration