1. Acute Respiratory Distress Syndrome
Taylor Wofford, MD
UNC Internal Medicine
July 14, 2009

2. Over the years… Shock lung Wet lung DaNang lung Stiff lung Pump lung …
Actut Respiratory Distress Syndrome

3. ARDS PaO2/FiO2 <200 Acute onset
Bilateral infiltrates c/w pulmonary edema
No clinical evidence for elevated LA pressure
(1994 American-European Consensus Conference Committee)

4. Pathophysiology
ARDS
Normal lung

5. Causes of ARDS Sepsis Aspiration Pneumonia Severe trauma/burns
Massive blood transfusion
TRALI
Relief of airway obstruction
Lung and BMT
Drug overdose
Pancreatitis
Near drowning
Smoke inhalation
Cardiopulmonary bypass
Venous air embolism
Neurogenic pulmonary edema

6. Evaluation of ARDS
ABG
CXR
Consider bronchoscopy
Infectious workup

7. Management of ARDS Mechanical ventilation Vt <6 mL/kg
PIP goal <40 cmH20
Permissive hypercapnea
High PEEP
Pressure mode > volume mode
FiO2 as low as possible
ARDS Network Study

8. Notable options Airway Pressure Release Ventilation (APRV) = BiVent NO
Prone positioning
High Frequency Oscillation
Recruitment maneuvers

9. Outcomes of ARDS 10-15% of ICU admissions 190,600 cases in US per year
Approximately 41% mortality

10. Bibliography
Evans TW. Respiratory Management in Critical Care. BMJ, 2004.
Fishman, AP. Shock lung: A distinict nonentity. Circulation 1973;47;
Green GB et al. The Washington Manual of Medical Therpeutics, 31st ed. Philadelphia: Lippincott Williams & Wilkins, 2004.
Husain AN. Pulmonary Pathology.
Siegel, MD. Acute respiratory distress syndrome: Pathophysiology; clinical manifestations; prognosis; and outcome. UpToDate.com, 2009.