1. Define acute lung injury
    • 1. PaO2/FiO2 < 300
    • 2. Bilateral pulmonary infiltrates
    • 3. PaO2 pressure < 18mmg Hg or no clinical evidance of left heart failure.
  2. Define ARDS
    Acute lung injury in which PaO2/FiO2 <200

    A (acute), R (restictive), D (Diffuse), S (shunt O2)
  3. Causes of ARDS
    Direct: aspiration, pneumonia and inhalation

    Indirect: Sepsis, pancreatitis, transfusion, truama
  4. Death from ARDS?
    uncomman. First 3 day its the underlying cause, After 3 days its sepsis.
  5. Treatment
    Always aggressively treat the underlying cause.

    Keep patient slightly hypovolumic (but enough to keep perfusion with low lactate. Target CVP

    Nutrition: entral

    And appropriate vent support
  6. Vent support setting for ARDS
    • Assist control / volume cycle
    • FiO2 : 1 then titrate down to <0.6
    • low tidal volumes: start at 8ml -> 6ml/Kg
    • Plateau pressure <30 mmHg
    • Inspiratory flow 60L/min
    • May try increase ratio ventilation

    • Permissive Hypercapnia
    • if acidotic then -> increase RR, increase TV, NaCO3

    7.15-7.30 -> increase RR till 35, or NCo3 or increase TV 1ml/kg
Card Set
Acute respiratory Distress syndromw