cover of episode Episode 195: ARDS

Episode 195: ARDS

2024/4/1
logo of podcast Core EM - Emergency Medicine Podcast

Core EM - Emergency Medicine Podcast

Shownotes Transcript

     [
        ](https://coreem.net/podcast/episode-195-ards/)         )

We review Acute Respiratory Distress Syndrome

Hosts: Sadakat Chowdhury, MD Brian Gilberti, MD

        [https://media.blubrry.com/coreem/content.blubrry.com/coreem/ARDS.mp3](https://media.blubrry.com/coreem/content.blubrry.com/coreem/ARDS.mp3))         
  
  
				
		 Download)
	
			
		 [Leave a Comment](https://coreem.net/podcast/episode-195-ards/#comments))
	

  		
									
				
				Tags: [Critical Care](https://coreem.net/tag/critical-care/)), [Pulmonary](https://coreem.net/tag/pulmonary/))				
				



  
              ## Show Notes

  • Definition of ARDS:

  • Non-cardiogenic pulmonary edema characterized by acute respiratory failure.

  • Berlin criteria for diagnosis include acute onset within 7 days, bilateral pulmonary infiltrates on imaging, not fully explained by cardiac failure or fluid overload, and impaired oxygenation with PaO2/FiO2 ratio <300 mmHg, even with positive end-expiratory pressure (PEEP) >5 cm H2O.

  • Severity based on oxygenation (Berlin criteria):

  • Mild: PaO2/FiO2 200-300 mmHg

  • Moderate: PaO2/FiO2 100-200 mmHg

  • Severe: PaO2/FiO2 <100 mmHg

  • Epidemiology:

  • Occurs in up to 23% of mechanically ventilated patients.

  • Mortality rate of 30-40%, primarily due to multiorgan failure.

  • Differentiation from Cardiogenic Pulmonary Edema:

  • Chest CT shows diffuse edema and pleural effusion in cardiogenic edema; patchy edema, dense consolidation in ARDS.

  • Ultrasound may show diffuse B lines in cardiogenic edema; patchy B lines and normal A lines in ARDS.

  • Pathophysiology:

  • Exudative phase: Immune-mediated alveolar damage, pulmonary edema, cytokine release.

  • Proliferative phase: Reabsorption of edema fluid.

  • Fibrotic phase: Potential for prolonged ventilation.

  • Etiology:

  • Direct lung injury (pneumonia, toxins, aspiration, trauma, drowning) and indirect causes (sepsis, pancreatitis, transfusion reactions, certain drugs).

  • Diagnostics:

  • Comprehensive workup including imaging (chest X-ray, CT), laboratory tests (complete blood count, basic metabolic panel, blood gases), and specialized tests depending on suspected etiology.

  • Management Strategies:

  • Steroids: Beneficial in certain etiologies of ARDS, with specifics on dosing and duration.

  • Fluid Management: Conservative fluid strategy, diuresis guided by patient condition.

  • Ventilation: Non-invasive ventilation (NIV) preferred in specific cases; mechanical ventilation strategies to ensure lung-protective ventilation.

  • Proning: Used in severe ARDS to improve oxygenation.

  • Inhaled Vasodilators: Used for refractory hypoxemia and specific complications like right heart failure.

  • Extracorporeal Membrane Oxygenation (ECMO): Considered for severe ARDS as salvage therapy.

  • Supportive Care: Includes monitoring and management of complications, nutrition, and physical therapy.

  • Ventilation Specifics:

  • Tidal volume and pressure settings aim for lung-protective strategies to prevent ventilator-induced lung injury.

  • Permissive hypercapnia, plateau pressure, PEEP, and ventilation mode adjustments based on patient response.

  • ARDSnet Table: ventilator_protocol_2008-07)

Read More)