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Acute Respiratory Distress Syndrome - Coggle Diagram
Acute Respiratory Distress Syndrome
Causes
Pulmonary
Pnumonia
Aspiration pnumonitis
Submersion/drowning
Extra-pulmonary
Sepsi
Burns
Trauma
TRALI
Pancreatitis
Cardiopulmonary bypass
Pathophysiology
Exudative Phase (days 2-4)
Inflammatory insult
leakage of protein rich fluid
Proliferative Phase (days 4-7)
Type 2 pnumocytes
Fibroblasts
Fibrotic Phase (7-14 days)
Scar formation
Management
ARDSNet
Ventilator Induced Lung Injury
Barotrauma
High pressure
Atelectasis
Shear forces
Biotrauma
Release of inflammatory mediators
Volutrauma
Overdistension
Lung Protective ventilation
Low tidal volumes 5-7mls/kg
Sp02 88-95%
OPtimum PEEP
Maintain plateau pressures <30cm H20
PROSEVA
16 hours a day
NNT 6
Pharmacological
Methylprednisalone
inhaled nitric oxide
ECMO
Murray Score
=3 - considered for ECMO
4 Categories
PEEP
Compliance
CXR (Quadrants infiltrated)
Pa02/Fi02 ratio
0-4 Score
Types
VA
VV
Extracorporeal C02 removal (ECCO2R)
Contraindications
Irreversible organ damage
Advanced malignancy
Severe pulmonary HTN
VA EMCO
Aortic regurgitation
Aortic dissection
Complications
Cannulation
Systemic anti-coagulation
Equipment
Oxygenator
Pump failure
Definition
Berlin Criteria
Ventilator dependent
PEEP>5
Acute
<1 weel
Radiographic
Bilateralobacification
Physiological
Severe
Pa/Fi02 <100
Moderate
Pa02/Fi02 100-200
Mild
Pa02/Fi02 200-300
Clinical
Respiratory failure not exaplined by LVH/fluid overload