Adult Respiratory Distress Syndrome

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Adult Respiratory Distress Syndrome


(ARDS)

Clinical Features

  • develops over 24-48 hours after insult
  • rapid, shallow breathing
  • severe hypoxaemia
  • stiff lungs
  • scattered crepitations
  • usually no cough / chest pain / haemoptysis
  • PaO2 low but PaCO2 normal unless very severe

Investigation

  • CXR
    • diffuse pulmonary shadowing
  • Echo / Catheterisation
    • normal pulmonary artery pressure

Pathology

  • increased capillary permeability → alveolar interstitial oedema
  • reduced lung compliance
  • leakage of fluid into alveolar spaces
  • right to left shunting of blood
  • hyaline membrane formation

Causes

Direct Insults

  • lung contusion
  • near drowning
  • aspiration of gastric acid
  • inhalation of smoke / corrosive chemicals
  • radiation pneumonitis

Systemic Insults

  • multiple trauma with shock
  • septic shock
  • severe acute pancreatitis
  • major head injuries
  • fat / air / amniotic fluid emboli
  • major blood transfusion reaction / massive blood transfusion
  • DIC
  • Cardiopulmonary bypass
  • Eclampsia
  • Severe allergic reactions
  • Drug overdose / sensitivity

Treatment

  • ITU
  • treat underlying cause
  • ventilation (PEEP)
  • fluid balance
    • may need CVP + Swann-Ganz catheter
    • not diuretics (no effect as is NOT heart failure)
  • prevent renal failure
    • dopamine

Prognosis

  • if complicated mortality ~90%

Complications

  • renal failure
  • interstitial fibrosis
 

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