ARDS AND ARF

ARDS

1. Severe dyspnea of rapid onset 2. Hypoxemia 3. Diffuse pulmonary infiltrates leading to respiratory failure

may be direct (toxic inhalation) or indirect (sepsis)

pneumonia aspiration of gastric content pulmonary contusion near drowning toxic inhalation injury

sepsis severe trauma multiple bone fractures flail chest head trauma burns multiple transfusion drug overdose pancreatitis postcardiopulmonary bypass

mild moderate severe

Severity: oxygenation Mild: 200-300 mmhg Moderate:100-200 mmhg Severe: <100 mmhg

chest radiograph

absence of left atrial hypertension

SEVERITY: OXYGENATION -mild:200-300 mmhg -moderate: 100-200 mmhg -severe:<100 mmhg ONSET CHEST RADIOGRAPH ABSENCE OF LEFT ATRIAL HYPERTENSION

5 cmh2O

1. pneumonia and sepsis (~40-60%) 2. aspiration of gastric contents 3. trauma 4. multiple transfusion 5. drug overdose

pulmonary contusion Multiple bone fractures Chest Wall trauma/flail chest

head trauma near drowning toxic inhalation burns

1. Exudative 2. Proliferative 3. Fibrotic

exudative

exudative

exudative

interleukin 1 IL 8, TNF-a lipid mediators - leukotriene B4

exudative

exudative

exudative

exudative

exudative

Alteration in alveolar spaces

Severe hypoxemia, increase in pulmonary dead space

First 7 days 12-36 h 5-7 days

1. Dyspnea - rapid shallow breathing 2. Tachypnea 3. Increased work of breathing result frequently in respiratory fatigue and ultimately in respiratory failure

opacities pulmonary edema

cardiogenic pulmonary edema

bilateral pulmonary infiltrates

7 to day 21