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Acute Respiratory Failure and ARDS - Coggle Diagram
Acute Respiratory Failure and ARDS
Acute Respiratory Failure
Definition
Failure of normal gas exhange leading to reduction in PaO2 and / or increase of PaCO2
CXR
Infiltrate is a chest XR finding
Opacification
Examination
Hypoxia
Tachypnoea
Dyspnoea
Cyanosis
Distressed
REduced SpO2 / SaO2 level
Reduced LoC
Hypercapnia
Tachypnoea
Reduced LoC / Coma
Reduced respiratory effort
Asterixis / Flap
Bounding pulses
Sound
Site
Unilat / Local /
Bilateral / global
Typrd
Monophonic wheeze
Upper airways stridor (foreign body)
Polyphonic wheeze
Small airway disease
ASthma, AECOPD
Crackles
Alveoli
CCF, pneumonia, ARDs
Pleural rub
Pleural disease
Pneumonia, PE
P/F ratio
𝑃𝑎𝑂2/𝐹𝑖𝑂2
is a clinical metric measuring lung oxygenation efficiency, calculated by dividing the arterial oxygen partial pressure by the fraction of inspired oxygen
Range
normal values at ≥400−500is greater than or equal to 400 minus 500 ≥400−500 mmHg, and values
mmHg, and values
≤300is less than or equal to 300
≤300
mmHg indicate lung injury or ARDS.
Berlin Criteria of ARDS
Timing
Hypoxaemia
Origin od oedema
Chest imaging
Matthay Modification 2024
Imaging
CT
or
Chest US
S:F ration - Saturation / Fraction of oxygenation
Oxygenation
Unibtubated ARDS ( NIV with PEEP at least 5cmH20 or high low O2 at least 30lpm
Intubated ARDS 3 categories of severity
S:F reation if SaO2 <97%
Pathophysiology
Fluid in alveoli
Increased hydrostatic pressure
NOT a cause of ARDs
Hearf faulure
FLuid overload
Breakdown in integrity of capillary - Increased capillary permeatability
CAUSE OF ARDS
Inflammatory insult from lung
Bilateral pneumonia
Aspiration pneumonia
Near drowning
Pulmonary haemorrhage
Distal inflammatory process
Sepsis
SIRs
Burn
Massive surgery
Managment
Assessment
Treatment
Address life threatening illness (ABCD)
Resotre oxygen and or CO2 levels to normal
Restore HR / BP to normal range asap
Identify and treat primary causes
Fix the number
Find the problem
Fix the problem
Primary Survery : Rule of Twos
A
Patent
Protected
B
SaO2
Resp rate
C
BP
HR
Nuero
Pupil respone to light
GCS
.Addressing Life threatening Issues - Tiers of care
Airway
Manual manouvre, rovery position
Naso or oropharyngeal airway
Articial airway
Breathing
Increae FiO2 delivery (up to high flow device)
Non invasive positive pressure ventilation
Invasive positive pressure ventilation
Oxygen Delivery
Nasal prongs
Concepts
Resevoir volume
Flow
Resevoir
the Higher FiO2 delivered by the device the larger the resovir
Moving up devices - resovoir gets bigger - ability to deliver FiO2 gets bigger
Flow
volume of O2 Depends on RR, resp cycle, inpiration volume
Nasal prongs: 6L /min
Face mask : 10L / min
High flow nasal : 70L / min
Hypercapnioeic ARF
Pump Failure
Conciousness
Fluid
Chest trauma
Increased Load / Pressure
Airway obstruction
Bronchospasm
Compressed abdominal compartment syndrome
ARDs
Id underlying causes
Lung protective ventilation
Prone position for mech ventilation
Maintain negative fluid balance
Neuromuscular blocking drugs may ahve a role
High frequency oscillatory ventilation in severe cases
Extracorporeal membrane oxygenation (ECMO) for refractory cases
Lung protective measures
Tidal volumens of 6-7ml/kg ideal body weight
High PEEP strategy
Maintain plateau pressure <30cmH20
Maintain driving pressure <15cmH20
Permissive hypercapnoea and avoid hyperoxia 88-92% in ARDS