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ARDS
slide notes
| Question | Answer |
|---|---|
| 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
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