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Acute Respiratory Distress Syndrome (Pathophysiology (Pulmonary epithelium…
Acute Respiratory Distress Syndrome
Definition
Most severe respiratory disorder
This is characterized as a potential diagnosis when one of the Risk Factors is recognized
Stiff lungs
Chest X Ray with new bilateral pulmonary infiltrates
Respiratory distress
No apparent cause of pulmonary edema but it is still there
Gas exchange abnormalities
Acute lung injury
Differential Diagnosis
Cardiac failure
Lung fibrosis
Causes
Unknown but sepsis is one of the main suspected causes
Pathophysiology
Pulmonary epithelium is damaged in the early stages and then causes there to be a reduced amount of surfactant
Pulmonary Hypertension
Non cardiogenic oedema leads to a generalized increased vascular permeability
Pulmonary Hypertension can then complicate the RVF and mean that mechanical obstruction of the pulmonary circulation can happen secondary to the interstitial edema.
Pulmonary vasoconstriction can then occur!
Shunts and dead spaces can increase meaning that compliance can fall and so can the airflow limitation
Clinical Presentation
Increasing hypoxaemia
Central cyanosis
Unexplained tachypnoea
Breathlessness
Fine crackles
CXR shows bilateral diffuse shadowing
Treatment
Diuretics, haemofiltration and fluid restrictions all help to reduce the pulmonary oedema problem
Lying forward
Mechanical ventilation
Inhaled NO (vasodilator)
Aerosolized surfactant