What is Acute Respiratory Distress Syndrome?
Acute respiratory distress syndrome is a severe form of acute lung injury characterized by sudden and progressive pulmonary edema increasing bilateral infiltrates hypoxemia,and responsible to Oxygen supplementation and the absence of an elevated left arterial pressure
What is the Etiology and risk factor for developing ARDS?
Factors associated with development of ARDS included
Risk factor for direct lung injury
1. Inhalation injury
2 aspiration of gastric content
3 near drowning
4 pulmonary contusion
5 pneumonia (bacterial viral fungal
Risk factor for indirect lung injury
Common causes
- sepsis
-severe traumatic injury
Less common causes
1. Sepsis non pulmonary sources
2. Non thoracic trauma
3. Major burn injury
4. Drug overdose
5. Transfusion of blood products
Pathophysiology of ARDS
Signs and symptoms of ARDS
1 severe dyspnea usually 12 to 48 hours after an initial event
2. Crackles may be present
3. Arterial hypoxemia not responsive to the oxygen supplementation
4. Lung injury then progress to fibrosis alveolitis with persistent severe hypoxemia
5 increased alveolar Dead space
ARDS diagnostic finding
1. History collection
2. Physical examination
3. Chest x-ray
- CXR - diffuse alveolar infiltrates, air bronchograms
4. Chest CT
5.Other test
- arterial blood gas analysis
-sputum culture and analysis
-bronchoscopy
-blood test
- Echocardiography
-Plasma brain natriuretic peptide ( BNP) levels
- Pulmonary artery catheterization
Medical management
Person with ARDS are hospitalized required treatment in an intensive care unit, no specific therapy for ARDS exists
1.Identify and treat the underlying condition, provide aggressive supportive care include
-Mechanical ventilation
-Circulatory support
-Adequate fluid volume
-Nutrition support
-TURN THE PATIENT FROM SUPINE TO PRONE, ANOTHER POSITION IS LATERAL ROTATION THERAPY
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2. Monitor ABG value, pulse oximeter and pulmonary function testing
3. Treat hypovolemia carefully avoid overload inotropic or vasopressor agent may be required
4.There is no specific pharmacology treatment for ARDS except supportive care
5.Numerous pharmacologic treatment are under investigation to stop the cascade of events leading to a ARDS, example surfactant a replacement therapy pulmonary antihypertensive agents, and antisepsis agents
6 pravin nutritional support 35 to 45 kcal per kg Daily
Nursing management
1.Closely monitor the patient frequently assess the effectiveness of treatment like oxygen administration, nebulizer therapy, chest physiotherapy, endotracheal intubation, and mechanical ventilation, suctioning, bronchoscopy.
2.Identify any problem with ventilation that may causes an anxity reaction: tube blockage other acute respiratory problem example : pneumothorax, pain sudden decrease in the oxygen level of dyspnea or ventilator malfunction
3.Sedation may be required to decrease the patient oxygen consumption allow the ventilator to provide the full support of ventilation and decrease patient anxity
Complications of ARDS
Common complications are
1. Nosocomial infection
2 Renal failure
Other complications are
1. Oxygen toxicity
2. Stress ulcers,
3. Tracheal ulceration,
4.Blood clots leading to deep vein thrombosis and pulmonary embolism.
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