Transcript Document

PART IX
Diffuse Alveolar Disease
Slide 1
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Chapter 27
Acute Respiratory Distress Syndrome
Figure 27-1. Adult respiratory distress syndrome.
Slide 2
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Anatomic Alterations of the Lungs
Slide 3

Interstitial and intra-alveolar edema
and hemorrhage

Alveolar consolidation

Intra-alveolar hyaline membrane

Pulmonary surfactant deficiency or
abnormality

Atelectasis
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Other Names Used to Identify ARDS
Slide 4

Adult respiratory distress syndrome

Adult hyaline membrane disease

Capillary leak syndrome

Congestion atelectasis

Da Nang lung

Hemorrhagic pulmonary edema

Noncardiac pulmonary edema

Oxygen pneumonitis

Oxygen toxicity
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Etiology:
Multitude of Factors
In alphabetical order, some of the better-known causes
Slide 5

Aspiration

Central nervous system disease

Cardiopulmonary bypass

Congestive heart failure

Disseminated intravascular coagulation

Drug overdose

Fat or air emboli

Infections

Inhalation of toxins and irritants
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Etiology:
Multitude of Factors
In alphabetical order, some of the better-known causes
 Inhalation of toxins and irritants
 Immunologic reaction
 Massive blood transfusions
 Nonthoracic trauma
 Oxygen toxicity
 Pulmonary ischemia
 Radiation-induced lung injury
 Shock (hypovolemia)
 Burns
 Thoracic trauma
Slide 6
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Overview of the Cardiopulmonary
Clinical Manifestations Associated
with ACUTE RESPIRATORY
DISTRESS SYNDROME
The following clinical manifestations result from
the pathophysiologic mechanisms caused (or
activated) by Atelectasis (see Figure 9-7),
Alveolar Consolidation (see Figure 9-8), and
Increased Alveolar-Capillary Membrane
Thickness (see Figure 9-9)—the major
anatomic alterations of the lungs associated
with ARDS (see Figure 27-1).
Slide 7
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Figure 9-7. Atelectasis clinical scenario.
Slide 8
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Figure 9-8. Alveolar consolidation clinical scenario.
Slide 9
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Figure 9-9. Increased alveolar-capillary membrane thickness clinical scenario.
Slide 10
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Clinical Data Obtained at the
Patient’s Bedside
Vital signs
Slide 11

Increased respiratory rate

Increased heart rate, cardiac output,
blood pressure
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Clinical Data Obtained at the
Patient’s Bedside
Slide 12

Substernal/intercostal retractions

Cyanosis

Chest assessment findings

Dull percussion note

Bronchial breath sounds

Crackles
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Figure 2-11. A short, dull, or flat percussion note is typically produced over areas of
alveolar consolidation.
Slide 13
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Figure 2-16. Auscultation of bronchial breath sounds over a consolidated lung unit.
Slide 14
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Clinical Data Obtained from
Laboratory Tests and Special
Procedures
Slide 15
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Pulmonary Function Study:
Expiratory Maneuver Findings
FVC

FEVT
N or 
FEF25%-75%
N or 
FEF200-1200
N
PEFR
MVV
FEF50%
FEV1%
N
Slide 16
N or 
N
N or 
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Pulmonary Function Study:
Lung Volume and Capacity Findings
VT
Slide 17
RV
FRC
TLC
N or 



VC

IC

ERV

RV/TLC%
N
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Decreased Diffusion Capacity
(DLCO)
Slide 18
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Arterial Blood Gases
Mild to Moderate ARDS

Acute alveolar hyperventilation with hypoxemia
pH

Slide 19
PaCO2

HCO3 (Slightly)
PaO2

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Time and Progression of Disease
Disease Onset
Alveolar Hyperventilation
100
90
PaO2 or PaCO2
80
Point at which PaO2
declines enough to
stimulate peripheral
oxygen receptors
70
60
PaO2
50
40
30
20
10
0
Figure 4-2. PaO2 and PaCO2 trends during acute alveolar hyperventilation.
Slide 20
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Arterial Blood Gases
Severe ARDS

Acute chronic ventilatory failure with hypoxemia
pH

Slide 21
PaCO2

HCO3 (Slightly)
PaO2

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Time and Progression of Disease
Disease Onset
Alveolar Hyperventilation
Acute Ventilatory Failure
100
90
Pa02 or PaC02
80
70
Point at which PaO2
declines enough to
stimulate peripheral
oxygen receptors
Point at which disease
becomes severe and patient
begins to become fatigued
60
50
40
30
20
10
0
Figure 4-7. PaO2 and PaCO2 trends during acute ventilatory failure.
Slide 22
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Oxygenation Indices
QS/QT
DO2
VO2


Normal
O2ER

Slide 23
C(a-v)O2
Normal
SvO2

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Hemodynamic Indices
(Severe ARDS)
Slide 24
CVP
RAP
PA
PCWP




CO
SV
SVI
CI




RVSWI
LVSWI
PVR
SVR




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Radiologic Findings
Chest radiograph
Slide 25

Increased density

Ground-glass appearance
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Figure 27-2. Chest X-ray of a patient with moderately severe ARDS.
Slide 26
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General Management of
ARDS
Respiratory care treatment protocols
Slide 27

Oxygen therapy protocol

Hyperinflation therapy protocol

Mechanical ventilation protocol
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General Management of
ARDS
Common ARDS mechanical ventilation
strategy:

Slide 28
Low-tidal volumes and high respiratory rates

4 to 8 mL/kg

Ventilatory rates as high as 35 breaths per minute

PEEP and/or CPAP—to offset atelectasis
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General Management of
ARDS
The therapeutic goals of low-tidal volume
ventilation
1. Decrease high transpulmonary pressure
2. Reduce overdistention of the lungs
3. Decrease barotrauma
Slide 29
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General Management of
ARDS
Medications and procedures commonly
prescribed by the physician
Slide 30

Antibiotics

Diuretics

Corticosteroids
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Classroom Discussion
Case Study: ARDS
Slide 31
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