Acute Respiratory Distress Syndrome (ARDS)<\/p>\n\n\n\n
RDS is a life-threatening form of respiratory failure characterized by inflammatory pulmonary edema
resulting in severe hypoxemia . ARDS is common, associated with substantial morbidity and frequently fatal. According to Berlin definition, ARDS is defined as an acute form of diffuse lung injury occurring in patients with a predisposing risk factor. Common risk factors of developing ARDS are pneumonia, sepsis, gastric content aspiration, trauma, pancreatitis, inhalation injury, burns, non-cardiogenic shock, drug overdose, transfusion-related acute lung injury (TRALI), and drowning.<\/p>\n\n\n\n
Timing: Onset within 1 week after the trigger insult
Imaging: Bilateral opacities on chest X-ray, not fully explained by effusion,
lobar\/lung collapse, or nodules
Non-cardiogenic origin
Respiratory failure not fully explained by cardiac failure or fluid overload<\/p>\n\n\n\n
Management of ARDS<\/p>\n\n\n\n The primary target in ARDS treatment is to ensure adequate gas exchange while minimizing the risk of ventilator induced lung injury. To date, the mainstay treatment is supportive. Lung protective ventilatory strategy is recommended to ensure adequate oxygenation and CO2 clearance, and minimizing the extent of damage due to mechanical ventilation when required.<\/p>\n\n\n\n Non-pharmacological intervention \uf0b7 Inhaled nitric oxide – Seemed promising in early trials, but in larger controlled trials, did not change mortality rates in adults with ARDS. Inhaled nitric oxide did not reduce mortality and may results in only a transient improvement in oxygenation.<\/p>\n\n\n\n Exacerbations of asthma is characterized by a progressive increase in symptoms of shortness of breath, cough, wheezing or chest tightness, and a progressive decrease in lung function. Acute exacerbation of asthma carries a high mortality. Patients who are at high risk of asthma-related death should be assessed carefully and should be managed in a high care setting. Risk of asthma-related death: Acute Respiratory Distress Syndrome (ARDS) RDS is a life-threatening form of respiratory failure characterized by inflammatory pulmonary edemaresulting in severe hypoxemia . ARDS is common, associated with substantial morbidity and frequently fatal. According to Berlin definition, ARDS is defined as an acute form of diffuse lung injury occurring in patients with a predisposing risk factor. […]<\/p>\n","protected":false},"author":1,"featured_media":0,"comment_status":"closed","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[1],"tags":[],"class_list":["post-625","post","type-post","status-publish","format-standard","hentry","category-med"],"_links":{"self":[{"href":"https:\/\/kidneydiseaseclinic.net\/blog\/wp-json\/wp\/v2\/posts\/625","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/kidneydiseaseclinic.net\/blog\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/kidneydiseaseclinic.net\/blog\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/kidneydiseaseclinic.net\/blog\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/kidneydiseaseclinic.net\/blog\/wp-json\/wp\/v2\/comments?post=625"}],"version-history":[{"count":2,"href":"https:\/\/kidneydiseaseclinic.net\/blog\/wp-json\/wp\/v2\/posts\/625\/revisions"}],"predecessor-version":[{"id":627,"href":"https:\/\/kidneydiseaseclinic.net\/blog\/wp-json\/wp\/v2\/posts\/625\/revisions\/627"}],"wp:attachment":[{"href":"https:\/\/kidneydiseaseclinic.net\/blog\/wp-json\/wp\/v2\/media?parent=625"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/kidneydiseaseclinic.net\/blog\/wp-json\/wp\/v2\/categories?post=625"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/kidneydiseaseclinic.net\/blog\/wp-json\/wp\/v2\/tags?post=625"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}
Classification<\/strong>
Presence of hypoxemia base on PaO2\/FiO2 ratio measured with PEEP \u22655 cm H2O:
\uf0b7 Mild (PaO2\/FiO2 201- 300 mm Hg)
\uf0b7 Moderate (PaO2\/FiO2 101-200 mm Hg)
\uf0b7 Severe (PaO2\/FiO2 \u2264 100 mm Hg<\/p>\n\n\n\n Management of ARDS <\/h2>\n\n\n\n
\uf0b7 Mechanical ventilation
\uf0b7 Lung recruitment and PEEP selection
\uf0b7 Tidal volume setting
\uf0b7 Oxygen and carbon dioxide target<\/p>\n\n\n\n
Pharmacological intervention<\/h2>\n\n\n\n
\uf0b7 Neuromuscular blocking agent – cisatracurium within 48 hours in severe ARDS patient has showed to
improve survival, increased the ventilator free days without increasing muscle weakness. A 48-hour
continuous infusion of cisatracurium in critically ill patients reduced the risk of death, reduced the risk of
barotrauma, and did not affect the duration of mechanical ventilation or the risk of ICU-acquired weakness.
\uf0b7 Corticosteroids – American College of Critical Care Medicine consensus recommends that glucocorticoid should be initiated early (<14 days of ARDS). Methylprednisolone of 1 mg\/kg\/ day for \u226514 days is recommended in patients with severe early ARDS. Glucocorticoids should be weaned and not stopped abruptly. Meduri et al. in its meta-analysis found that methylprednisolone at dose 1-2mg\/kg\/day for \u22657 days reduced ICU mortality rates.
<\/p>\n\n\n\nAcute Exacerbation of Asthma<\/h2>\n\n\n\n
\uf0b7 History of near-fatal asthma requiring intubation and mechanical ventilation
\uf0b7 Hospitalization or emergency care visit for asthma in the past year
\uf0b7 Currently using or having recently stopped using oral corticosteroids (a marker of event severity)
\uf0b7 Over-use of SABAs, especially the use of more than one canister of salbutamol (or equivalent) monthly
\uf0b7 A history of psychiatric disease or psychosocial problems
\uf0b7 Poor adherence with asthma medications and\/or poor adherence with (or lack of) a written asthma action plan
\uf0b7 Food allergy in a patient with asthma<\/p>\n","protected":false},"excerpt":{"rendered":"