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By Karine Frangulyan February 11, 2011

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ARDS is a sudden, progressive form of respiratory failure characterized by: - severe dyspnea - refractory hypoxemia - diffuse bilateral infiltrates

` ARDS follows acute and massive lung injury 150 ± 200 mmHg < PaO2/FIO2 < 250 ± 300 mmHg ` ‡ARDS ±PaO2/FIO2 < 150 ± 200 mmHg .

` Other names for ARDS: Shock Lung Wet Lung Post-Traumatic Lung Congestive Atelectasis Capillary Leak Syndrome Adult Hyaline Membrane Disease .

inhalation of noxious fumes or fluids (e.` ARDS develops as a result of ischemia in the alveolar capillary membrane during shock. . gastric acid)..g. or inflammation from pneumonia or sepsis. oxygen toxicity.

bacterial or fungal pneumonias Lung contusion Fat embolus Aspiration Massive smoke inhalation Inhaled Toxins Prolonged exposures to high concentrations of oxygen .` Direct Pulmonary Trauma Viral.

Indirect Pulmonary Trauma Sepsis Shock Multisystem trauma Disseminated Intravascular ««.coagulation Pancreatitis Uremia Drug overdose Anaphylaxis Idiopathic Prolonged heart bypass surgery Massive blood transfusions Pregnancy-induced hypertension Increased intracranial pressure Radiation Therapy .

` This leads to the development of non-cardiogenic pulmonary edema. which decreases lung compliance and impairs oxygen transport.` The hallmark is a massive inflammatory response by the lungs that increases permeability of the alveolar membrane with resultant fluid movement into the interstitial and alveolar spaces. .

1. Exudative (acute) phase > 1-4 days Basement membrane disruption x Type I pneumocytes destroyed x Type II pneumocytes preserved Surfactant deficiency x inhibited by fibrin x decreased type II production Microatelectasis / alveolar collapse .

Proliferative phase > 7 .2.10 days Type II pneumocyte x proliferate x differentiate into Type I cells x reline alveolar walls Fibroblast proliferation x interstitial/alveolar fibrosis .

>14 days Characterized by: x local fibrosis x vascular obliteration Repair process: x resolution vs fibrosis . Fibrotic phase .3.

` Acute dyspnea/tachypnea rales/rhonchi/wheezing Resistant hypoxemia PaO2/FIO2 < 150 200 mmHg CXR diffuse. bilateral infiltrates No evidence of LV failure (PAWP < 18 mmHg) ` ` ` .

` ` The keys to successful management of ARDS are early detection and initiation of treatment. Goals of medical management are: Respiratory and Ventilatory support Maintenance of hemodynamic stability Treatment of the underlying cause Prevention of complications .

` Respiratory and Ventilatory support The goal is to use the least amount of Fio2 and PEEP possible to maintain O2 saturation at or above 90% while decreasing the potential of O2 toxicity. Inverse ratio ventilation (IRV) Nitric Oxide Antioxidants Prone position Kinetic Therapy .

g.` Maintenance of hemodynamic stability Used to observe the effect of fluids and degree of pulmonary edema. dobutamine or dopamine) may be indicated to improve cardiac output and to increase systemic blood pressure.. . Inotroic agents (e.

Indiscriminate use to be avoided. .` Treatment of the underlying cause Administration of antibiotics if infection is suspected or present. Administration of steroids to reduce inflammatory response.

` Prevention of complications such as: Cardiac Dysrhythmias Sepsis from invasive lines Disseminated intravascular coagulation (DIC) .

` ` ` ` Placing the client in prone position Evaluation of client¶s response to treatment Monitoring for complications Emotional support of clients family .

Question #1 1. Which intervention would be most likely to prevent ARDS? a. Monitoring pts for signs of hypercapnia (d). Teach cigarette smoking cessation b. Replacing fluids. adequately during hypovolemic states . Maintaining adequate serum K levels c.

Question #2 Early sign of ARDS in a pt at risk? a. unexplained electrolyte imbalance . Elevated CO2 level (b). Metabolic acidosis d. Severe. Hypoxia not responsive to O2 c.

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` ` Black.. Missouri: Sounders Elsevier.M.org . J.ards. Hawks. Louis. J. www. 8th Edition. St. (2009) Medical-surgical nursing clinical management for positive outcome.H.