ARDS & ARF

Hypoxemic & Hypercapnic

• V/Q Mismatch
• Shunting
• Diffusion Limitation
• Hypoventilation

• Abnormalities in:
• Airway & alveoli
• central nervous system
• chest wall
• neuromuscular conditions

Pulse Ox, ABG, CXR, CBC, electrolytes, ECG, cultures, V/Q scan/Pulmonary angiography, End Tidal CO₂, hemodynamic monitoring

Nasal Cannula, face mask, BiPAP/CPAP, mechanical ventilation

• Oxygen Toxicity:
• exposure >60% O₂ for more than 48 hrs

• CO₂ Narcosis
• Blunted response of chemoreceptors in medulla due to chronic hypercarbia
• Proved oxygen to improve ABGs

Coughing, positioning, hydration, humidification, chest physical therapy, airway suctioning

relief of bronchospasm, reduce airway inflammation, reduce pulmonary congestion, treat pulmonary infections, reduce anxiety & restlessness

Alveolar capillary membrane becomes damaged and more permeable to fluid.

• severe dyspnea, refractory hypoxemia, reduced lung compliance, diffuse pulmonary infiltrates
• (lung fluid overload)

PaO₂ < 50 mm Hg OR FiO₂ >40% w/ PEEP > 5 cm H₂O

PaO₂/FiO₂ ratio below 200 despite increased FiO₂ by mask, cannula, or ETT

nosocomial pneumonia, barotrauma & volupressure trauma, stress ulcers, renal failure, multi-organ dysfunction syndrome

High flow oxygen therapy, mechanical ventilation with PEEP, prone positioning, lateral rotation therapy, ECMO

• Fine line between overload and depletion
• Mild fluid restrictions/diuretics prn
• Assessment: I&O, lung sounds, edema, weight gain/loss

Surfactant replacement therapy, partial liquid ventilation, methylprednisolone, prostaglandin E1, monoclonal antibodies, high frequency jet ventilataion