ARDS AND VENTILATORY STRATEGIES

MODERATORS: DR. CH. MURALI SIR

. DR. VASU PRAKASH SIR
CHAIRPERSON:- DR. BHARATHI MA’AM
SPEAKER: DR. G. SIDHARTH
DEFINITION
Insult to the lungs
1. Direct 2. Indirect
 PATHOPHYSIOLOGY
• Inflammatory cytokines and exogenous agents injure the epithelium and the
endothelium of the lung.
1. Primary ARDS – Occurs locally
2. Secondary ARDS – Due to secondary inflammatory response
• Pulmonary edema due to breach in the alveolocapillary
barrier.
• Alveolar pooling and interstitial edema
• Surfactant dysfunction
STAGES OF ARDS
CELLS AND MEDIATORS
1. Cells:-
• NEUTROPHILS
• ALVEOLAR MACROPHAGES (M/C)
• EPITHELIAL CELLS
• ENDOTHELIUM
2. Mediators:-
• TNF alpha, IL-1beta, IL-6 , IL-8( PROINFLAMMATORY)
• IL-10(COUNTER REGULATORY)
CLINICAL PRESENTATION

• Tachypnea
• Tachycardia
• Hypoxemia
• PaO2/FiO2 decreases,
• PaCO2 increases
SEVERE HYPOXIA , INCREASED DEADSPACE VENTILATION AND FATIGUE LEADS
TO VENTILATORY FAILURE.
PULMONARY EDEMA IS NON CARDIAC ORIGIN.
• Mechanical ventilation is a SUPPORT SYSTEM not the treatment.
• Primary disease is responsible for 95% of mortality.
Due to interstitial oedema and increased lung
weight there is increase in superimposed
pressure leading to BABY LUNG
• Baby lung indicates small lung but not stiff lung as there is reduced FRC.
• Heterogenouse involvement of the lung(dorsal and basal portions>>Ventral
and apical)
CONSEQUENCES OF MECHANICAL
VENTILATION IN ARDS
MECHANICAL VENTILATION IN ARDS
VILI
Stress:- Pressure applied per unit area
Strain:- Change in shape in response to the stress
applied.
SMALL FRC Increased Strain
 TRANSPULMONARY PRESSURE
TRANSPULMONARY PRESSURE
Plateau pressure – Pleural pressure
• It’s the main determinant of VILI
STRAIN = Vt/ FRC
As FRC decreases tidal volume has to be reduced
MECHANICAL POWER
STRESS AMPLIFICATION
LUNG PROTECTIVE VENTILATION(LPV) IS TO BE
PRACTISED
OXYGEN TOXICITY<< VOLUTRAUMA
LUNG PROTECTIVE STRATEGIES

PERMISSIVE HYPERCAPNIA = PH:- 7.20-

7.25 IS TOLERABLE
RECRUITMENT MANEUVER
• 1. PEEP
• 2. PRONE POSITIONING
PRONE POSITIONING TO BE DONE FOR 12-16 HOURS
INDICATION : WHEN PaO2/FiO2 < 150