(Adult) Acute Respiratory Distress Syndrome Paramedic Program Chemeketa Community College

What in the heck is ARDS? A fulminent form of respiratory failure Noncardiac pulmonary edema Acute lung inflammation Diffuse alveolar-capillary injury ~ 200,000 cases per year Mortality 40-70% Severe hypoxia

Intrapulmonary shunting Reduced lung compliance Irreversible parenchymal lung damage Usually healthy lungs before event More common in men

A complication of injury or illness Trauma Direct pulmonary injury Multiple trauma Gram-negative sepsis Gastric aspiration Cardiopulmonary bypass surgery

Complications, cont. Multiple blood transfusions Oxygen toxicity Toxic inhalation Pneumonia OD (tricyclics, heroin, methadone, barbiturates, salicylates) Infections Drowning (12-24 hours)

Yes, but what happens? Increased capillary permeability = wet congested lungs; decreased perfusion capacity Decreased pulmonary compliance Requires higher airway pressure

3 phases Exudative phase – injury to endothelium and epithelium, inflammation, fluid exudation Fibroproliferative phase – influx and proliferation of fibroblasts; injury may begin to resolve or become persistant Fibrosis phase – resolution of inflammation; development of pulmonary fibrosis

pH=7.47 pCO 2 =31 pO 2 =59 Saturation 91 pH=7.45 pCO 2 =34 pO 2 =182 Saturation 99.5

The patient Onset w/in 72 hours Mild tachypnea may be only manifestation Labored breathing, tachypnea Cyanosis Moist skin Hyperventilation Scattered crackles/rales

Absent signs of volume overload – 3 rd heart sound, JVD, Agitation Lethargy Obtundation

DDX CHF Pulmonary edema Aspiration pneumonia Bacterial pneumonia Immunocompromised pneumonia Viral pneumonia Smoke inhalation Cardogenic pulmonary edema

Complications Respiratory failure Cardiac dysrhythmias Disseminated Intravascular Coagulation Barotrauma Congestive Heart Failure Renal failure Multiple organ failure

Management Always – high oxygen Sa0 2 IV ET prn PEEP or CPAP Maintain Sa0 2 at 92-94% Fluid replacement to maintain cardiac output Corticosteroids - controversial Diuretics

Management, cont. Consider Dobutamine 2.5 mcg/kg/min; titrate to effect

Work up in the ED ABG’s CXR Sputum collection

Important to recognize Patients who have been resuscitated may have a period of relative stability followed by deterioration