Management of Acute Respiratory Distress Syndrome PDF
Preview Management of Acute Respiratory Distress Syndrome
2015 Winter Anesthesia Conference Management of Acute Respiratory Distress Syndrome Ronald Pearl, MD, PhD Professor and Chair Department of Anesthesiology Stanford University [email protected] Disclosures • No financial disclosures Learning Objectives • At the conclusion of the activity participants should be able to: – Discuss mechanisms of ventilator-associated lung injury and how appropriate ventilator management of the patient with ARDS can prevent such injury – Discuss fluid management of the patient with ARDS in the context of issues of systemic perfusion – Recognize complications associated with the use of high tidal volume, low PEEP ventilation in the operating room and the ICU Intraoperative Ventilation in ARDS • Blum, Anesthesiology 2011; 115:75 U. Michigan database 2005-2009 8.7 ml/kg TV 5 cm PEEP FIO 0.9 2 PIP ≈ 30 cm Acute Respiratory Distress Syndrome • 23 year old woman involved in MVA – Bilateral chest contusions – Ruptured spleen – 15 units PRBC – Over next 2 days develops diffuse fever, tachycardia, bilateral infiltrates, hypoxemia on mechanical ventilation with 100% oxygen, increased bilirubin – What is the management and prognosis? Acute Respiratory Distress Syndrome • 23 year old man involved in MVA – Bilateral chest contusions – Ruptured spleen – Massive transfusion in the ED – Over next 2 days develops diffuse fever, tachycardia, bilateral infiltrates, and hypoxemia – What is the management and prognosis? ARDS • Which of the following interventions have been demonstrated to improve outcome in the patient with ARDS: – Tidal volume of 6 mL/kg – Fluid restriction – Pulmonary artery catheter monitoring – Inhaled nitric oxide – High dose steroids ARDS • Ashbaugh, Lancet 1967;12;319 – 12 patients with tachypnea, hypoxemia, and decreased compliance following trauma, aspiration, or pulmonary infection – Improved oxygenation with PEEP – 60% mortality – Hyaline membrane formation on autopsy – “Adult respiratory distress syndrome” American-European Consensus Conference (1994) • Acute lung injury – a syndrome of inflammation and increased permeability – cannot be explained by left atrial or pulmonary capillary hypertension – acute in onset and persistent
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