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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.
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Define ARDS
Acute lung injury in which PaO2/FiO2 <200
A (acute), R (restictive), D (Diffuse), S (shunt O2)
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Causes of ARDS
Direct: aspiration, pneumonia and inhalation
Indirect: Sepsis, pancreatitis, transfusion, truama
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Death from ARDS?
uncomman. First 3 day its the underlying cause, After 3 days its sepsis.
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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
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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
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