Adult Respiratory Distress Syndrome Kathy Plitnick RN PhD CCRN NUR 351 Critical Care Nursing

ARDS Form of acute noncardiogenic pulmonary edema Occurs secondary to another event Increased capillary permeability that precipitates a condition – lungs become wet, heavy, congested, hemorrhagic, stiff & unable to diffuse oxygen

Precipitating Event Direct Pulmonary injury: aspiration, near drowning, pneumonia, trauma, embolism, O 2 toxicity, smoke inhalation Indirect: sepsis, pancreatitis, massive blood transfusions, multiple trauma, DIC, shock, CPB, anaphylaxis

Lung Injury Neutrophils release chemical mediators Increase in capillary membrane permeability Fluids & proteins leak into pulmonary interstitium/alveoli Alveoli collapse Severe hypoxemia & decreased lung compliance

Lung Injury Bronchoconstriction Destroyed elastin and collagen fibers of the lung Edema & scarring of lungs Microemboli form Fibrotic changes

Physiologic Manifestations Stiff Lungs Shunting Increased alveolar deadspace ventilation V/Q mismatching Bronchovascular edema

Clinical Manifestations Dyspnea, tachypnea Tachycardia, decreased BP Mental status changes Crackles, wheezes ABG’s, CXR PFT – decreased VC, VE, FRC

Treatment Supportive Mechanical Ventilation PEEP Prone Positioning Therapeutic Fluids & Electrolytes Nutrition Sedation Inotropes Curative Treat underlying cause

Other Therapies Medications NSAIDS Surfactact Replacement Antioxidants Inhaled Nitric Oxide Liquid Ventilation ECMO/IVOX