SHM's Clinical Quick Talks-Approach to Acute Respiratory Distress Syndrome (ARDS)

Pdf Summary

The document outlines an approach to diagnosing and managing Acute Respiratory Distress Syndrome (ARDS). ARDS is typically triggered by alveolar injury leading to the release of pro-inflammatory cytokines that recruit neutrophils, which in turn release proteases damaging the alveolar-capillary barrier. This results in impaired gas exchange and reduced lung compliance.<br /><br />Common causes of ARDS include sepsis (especially in patients with chronic alcohol use), aspiration of gastric contents, pneumonia, severe trauma, massive transfusions, drug use, and acute pancreatitis. Diagnosis is primarily clinical, necessitating evidence of hypoxemic respiratory failure and chest imaging showing bilateral infiltrates, along with signs of worsening dyspnea. The diagnostic criteria consider the PaO2:FiO2 ratio, with values ranging from 201-300 mmHg for mild ARDS, 101-200 mmHg for moderate ARDS, and less than 100 mmHg for severe cases.<br /><br />Differentiating ARDS from other conditions like heart failure or diffuse alveolar hemorrhage is essential and can involve correlating clinical signs with echocardiography and bronchoscopic confirmation.<br /><br />The treatment for ARDS emphasizes lung-protective ventilation with low tidal volumes and careful monitoring of plateau and driving pressures. Proning and paralytics are recommended, especially in moderate to severe cases. Use of pulmonary inhaled vasodilators and glucocorticoids like dexamethasone is also considered in severe cases. ECMO may be used when conventional methods fail to maintain adequate oxygenation.<br /><br />The document emphasizes treating the underlying cause of ARDS and anticipates potential complications such as pneumothorax or ventilator-associated pneumonia. Research supports the use of lung-protective strategies, proning, and, in some cases, extracorporeal membrane oxygenation (ECMO) for mortality benefit.

Asset Subtitle

Patricia Rodriguez, Kathryn Haroldson

Keywords

Acute Respiratory Distress Syndrome

ARDS

alveolar injury

hypoxemic respiratory failure

lung-protective ventilation

proning

pulmonary inhaled vasodilators

extracorporeal membrane oxygenation

dexamethasone

pneumothorax