Description
Acute respiratory distress syndrome (ARDS) is characterized by the development of unforeseen breathlessness within hours to days of an inciting indeed. Survivors of ARDS may recover normal lung function. Still, some of them may have residual lung impairment or patient muscle weakness. Generally, the lung dysfunction is mild, but ARDS can lead to severe lung damage and a reduced health- related quality of life.This webinar will help you understand the best management patterns of ARDS.
Résumé
- ARDS is a clinical syndrome, not a disease, defined by acute onset respiratory failure within seven days, a PaO2/FiO2 ratio less than 300, ruling out cardiac failure or fluid overload, and bilateral opacities on chest imaging. The Berlin definition classifies ARDS into mild, moderate, and severe based on the PaO2/FiO2 ratio. Limitations include the impact of PEEP settings, FiO2 accuracy, and timing of measurements post-setting changes.
- Understanding shunt fraction, the proportion of blood bypassing oxygenation in the lungs, is crucial for managing FiO2 levels. This helps differentiate between ventilation-perfusion mismatch (shunt) and dead space ventilation (good ventilation but poor perfusion, common in pulmonary embolism).
- Risk factors for ARDS include pneumonia, aspiration, extra-pulmonary causes like polytrauma or pancreatitis (via cytokine storms), sepsis, and transfusion-related acute lung injury (TRALI). Ventilator-induced lung injury (VILI) due to high tidal volumes is also a significant concern. Identifying and addressing the underlying cause is crucial for effective management.
- The ARDSNet protocol, using low tidal volume (6-8 ml/kg of ideal body weight) and high respiratory rate, is a cornerstone of lung-protective ventilation. Target peak pressure less than 35 cmH2O and plateau pressure less than 30 cmH2O. Maintain oxygen saturation at 85-90% and pH above 7.2, allowing permissive hypercapnia.
- Prone ventilation, placing the patient face down, is beneficial as it utilizes the larger dorsal lung volume. Early prone positioning for at least 16 hours at a time improves outcomes. While non-invasive ventilation (NIV) has limited evidence, recent studies suggest potential benefits in select cases.
- Adjunctive therapies include neuromuscular blockers to improve ventilator synchrony (use boluses rather than continuous infusions), low-dose corticosteroids, and conservative fluid management. Early diagnosis and a proactive approach to weaning from mechanical ventilation are essential.
- VV-ECMO is considered when conventional strategies fail to maintain adequate oxygenation. The best ECMO outcomes are seen in patients with isolated lung failure. Neuro muscular blockade is needed when patients fight against ventilator.
- ARDS outcomes vary based on etiology. Trauma and TRALI generally have better prognoses than pneumonia, aspiration, or sepsis-induced ARDS. Adherence to ARDSNet protocols and minimizing ventilator-induced lung injury are crucial for improving survival.
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À propos des intervenants
Dr Raj Raval
Chief Medical Officer, Founder & Director
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