ARDS is a syndrome of severe hypoxaemia and may be a challenge for every physician who has a chance to take care of this poor patient. The criteria for diagnosis of this syndrome are usually composed of bilateral pulmonary oedema, the cause is not cardiac in origin, and it is usually refractory to oxygen therapy.
In the world of Surgical ICU these poor patients may have risk factors for ARDS from aspiration pneumonitis, sepsis or septic shock, pancreatitis, massive blood transfusion or TRALI (transfusion related acute lung injury). These patients usually have a very high risk of morbidity and mortality.
The treatment option is mainly the ventilation support to correct the patient to have an acceptable of oxygenation, the main part is PEEP titration since they are usually severe hypoxia from flooded alveoli, the PEEP setting helps open the collapsed alveoli and prevent the recruited alveoli derecruited again. Since the pulmonary mechanics especially compliance (that is physiology the basic science) is so poor meaning that it is more difficult to ventilate your patient and the very high pressure to open the alveoli required.
If you are more interested in this syndrome, please check at the ARDS net for the table of FiO2 and PEEP level, and also the principles of lung protective strategy in order to attenuate the complications of barotrauma or volutrauma from the application of IPPV in this poor patient group.
Some people may turn the patient prone, because with the blood flow is dependent on the gravity which means that blood flow is more likely to be in the dorsal region when the patient lies supine, but the ventilation is more on the front. However, when you turn your patient prone, unexpectedly the blood flow is still on the back region of the thoracic cage which is now on the independent part of the thorax, but the ventilation still goes to the independent part, therefore, ventilation/perfusion (V/Q) are more matched than it was in the supine position.
One more thing that you have to consider when you have to care for the patients with the ARDS is the fluid balance, with the concept of "Less is More" should be applied to this patient group. When you give more fluids to the patients with organ dysfunction especially the kidney, fluid cannot go anywhere but the lung and other body tissues. Therefore, this overloaded fluid would definitely affect the oxygen exchange in the poor and dysfunction alveoli.
In the world of Surgical ICU these poor patients may have risk factors for ARDS from aspiration pneumonitis, sepsis or septic shock, pancreatitis, massive blood transfusion or TRALI (transfusion related acute lung injury). These patients usually have a very high risk of morbidity and mortality.
The treatment option is mainly the ventilation support to correct the patient to have an acceptable of oxygenation, the main part is PEEP titration since they are usually severe hypoxia from flooded alveoli, the PEEP setting helps open the collapsed alveoli and prevent the recruited alveoli derecruited again. Since the pulmonary mechanics especially compliance (that is physiology the basic science) is so poor meaning that it is more difficult to ventilate your patient and the very high pressure to open the alveoli required.
If you are more interested in this syndrome, please check at the ARDS net for the table of FiO2 and PEEP level, and also the principles of lung protective strategy in order to attenuate the complications of barotrauma or volutrauma from the application of IPPV in this poor patient group.
Some people may turn the patient prone, because with the blood flow is dependent on the gravity which means that blood flow is more likely to be in the dorsal region when the patient lies supine, but the ventilation is more on the front. However, when you turn your patient prone, unexpectedly the blood flow is still on the back region of the thoracic cage which is now on the independent part of the thorax, but the ventilation still goes to the independent part, therefore, ventilation/perfusion (V/Q) are more matched than it was in the supine position.
One more thing that you have to consider when you have to care for the patients with the ARDS is the fluid balance, with the concept of "Less is More" should be applied to this patient group. When you give more fluids to the patients with organ dysfunction especially the kidney, fluid cannot go anywhere but the lung and other body tissues. Therefore, this overloaded fluid would definitely affect the oxygen exchange in the poor and dysfunction alveoli.
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