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ARDS/ARF definition Pathologic acute injury to the lung (direct or indirect). Inflammatory syndrome marked by disruption of alveolar-capillary membrane
Mortality rate of ARDS Very deadly, 50%
What are the symptoms of ARDS? Decreased lung compliance -Resulting in falling PO2 despite increase FiO2******* Decreased surfactant -Resulting in atelectasis Increase in # of neutrophils and macrophages (“Phil and Mac attack”) -Resulting in PROTEIN-RICH pulmonary edema
What are the causes of ARDS/ALI? Direct Lung Injury: IN the lung --aspiration, trauma, pneumonia Indirect Lung injury: from the blood --Sepsis, cardiopulmonary bypass, pancreatitis, transfusions
What is capnometry? Measuring the amount of CO2 within/given off by the patient
PETCO2 partial pressure of end tidal CO2. i) Measured by the ventilator and is 1-5mm < PaC02 in the STABLE patient. ii) An extremely abnormal value indicates CO2 retention and could be an ominous sign of a change in condition. However……
Permissive hypercapnia Maintaining lower tidal volumes to cause a rise in PaCO2 keeping pH above 7.25. This helps to prevent Barotrauma/Volutrauma. Keep in mind this is risky business, CO2 very strong vasodilator.GOAL: Maintain PaCO2 less than or equal to 60 mmHg and peak airw
What position should patient be in for when caring ALI/ARDS? a) PRONE POSITIONING i) Strongly supported by EBP ii) Shifts edema and recruits aveoli iii) Change in position= Improved oxygenation!
Supportive care for ARDS means you treat UNDERLYING CONDITION i) Interrupt inflammatory cascade (1) Monitor Protein C as it is a marker for SYSTEMIC INFLAMMATION. ii) Decrease Oxygen demand and promote sleep and rest (1) Cluster your care to allow maximal rest for the patient
Make sure that ARDS patient has : Maintain SaO2 >90% using LOWEST FiO2 (decreased chance of O2 toxicity),Head of bed > 30 degrees,GOOD ORAL CARE TO PREVENT PNEUMONIA,Mobility, ROM, Q2 Turns
Medications typically used with ARDS patients i) Inhaled Nitric Oxide (Pulmonary vasodilation),Steroids (still controversial),Anti-inflammatory agents
Confusion/restlessness are early signs of CO2 retention
Pa02/ Fi02 ratio 80 / 20% (room air) = 400
Hypoxemia is ---- oxygen therapy refractory "A falling P02 in the face of a rising Fi02"
BOOP Bronchiolitis Obliterans Organizing Pneumonia
CARS Compensatory Anti-inflammatory Response Syndrome (more susceptible to infection)
COP Cryptogenic Organizing Pneumonitis
DAD Diffuse Alveolar Damage
Type I alveolar epithelial cells 90% total alveolar surface within lungs Highly susceptible to injury  inflammation
Type II alveolar epithelial cells Produce, store, secrete pulmonary surfactant 10% total alveolar surface within lungs disruption of synthesis/storage of surfactant  collapse of alveoli, impairment of pulmonary gas exchange, development of fibrosis and loss of compliance “stiff lungs”
In 2002 Severe Acute Respiratory Syndrome, or SARS killed 15% of those infected
Of the H1N1 influenza A (swine flu) 2009/2010 18,000 deaths 14 – 46% mortality rate primarily from ARDS
Created by: UARN85