ACUTE RESPIRATORY DISTRESS SYNDROME

Moderator Professor Dr. Raghu Ram Osmania General Hospital Speaker Dr. krishna Murthy (P.G)

Acute Respiratory Distress Syndrome

(OR) Adult Respiratory Distress Syndrome (OR)

Post traumatic massive pulmonary collapse

(OR) Adult hyaline membrane Disease (OR) Respiratory lung (OR) Pump lung Hemorrhagic lung syndrome (OR) Congestive Atelectasis

 HISTORICAL BACKGROUND: The first description of ARDS appears in Rene Laennecs account of idiopathic anasarca of the lungs, published in 1821. ARDS was first described in 1967 by Ashbaug and Colleagues. In 1988 an expanded definition was proposed which quantified physiologic respiratory impairment.

In 1994 a new definition was recommended by the American European consensus conference committee.
It had two advantages; 1) It recognizes the severity of pulmonary injury 2) It is simple to use

DEFINITION: ARDS defined as: 1. Acute onset 2. Bilateral, white, patchy, infiltrates on chest radiograph (this infiltrates may appears similar to those of left ventricular failure but cardiac silhoutte appears normal in ARDS).

3. Ratio of arterial partial oxygen tension (PaO2) as fraction of inspired oxygen (FiO2) below 200 mm of Hg PaO2/FiO2<200mmHg. 4. Pulmonary artery capillary wedge pressure less than 18 mm of Hg (lack of clinical evidence of left ventricular failure ), but raised in left ventricular failure.

1994 American European consensus Conference Committee Definition

Condition Timings
Oxygenation Chest Radiograph Pulmonary occlusion Pressure

ALI

Acute onset

PaO2/ Fi02 < 300 Torr

Bilateral infiltrates on frontal chest Radiograph Bilateral infiltrates on frontal chest Radiograph

< 18 mm of Hg when measured or no clinical evidence of left atrial HTN < 18 mm of Hg when measured or no clinical evidence of left atrial HTN

Acute onset ARDS

PaO2/ Fi02 < 200 Torr

 INCIDENCE: In 1972 national institute of health panel estimated the

incidence of ARDS to be approximately 75 per 1 lakh

population per year but in a prospective studies, the incidence of ARDS has been reported to range from 1.5

-13.5 cases per 1 lakh population per year.

PREVELENCE: Brun and Buisson 2004 reported prevalence of 16% in ventilated patients admitted more than 4 hours. RISK FACTORS: The clinical conditions associated with development of ARDS has been identified and these conditions are

divided in to two categories those that causes direct lung injury

DIRECT CAUSES Pneumonia

INDIRECT CAUSES (BLOOD BORNE) Infection Sepsis Diffuse pulmonary infection: Viral Mycoplasma Pneumocystic pneumonia Miliary tuberculosis Major blood transfusion reactions Cardio pulmonary bypass Disseminated intravascular coagulation (DIC) Acute hemorrhagic pancreatitis Uremia

Aspiration of gastric contents

Mechanical trauma
including head injuries Near drowning Fractures with fat embolism

Burns
Pulmonary contusion

Drug over dose:

Ionizing radiation Blunt injury to chest Reperfusion Pulmonary oedema Inhaled irritance Oxygen toxicity Smoke Irritant gases and chemicals

Heroin, Methadone
Acetyl salicylic acid Barbiturates overdose Paraquat Anaphylaxis - (Wasp,

Bee, Snake venom)

Obstretic crisis (amniotic fluid embolism,

eclampsia)
Carcinomatosis Severe burns

CAUSES OF RESPIRATORY FAILURE IN CHILDREN: Impaired control of ventilation: Head trauma

Intracranial hemorrhage
Increased intracranial pressure (secondary to tumors, edema, hydrocephalus, Reyes syndrome) Central nervous system infection Drug intoxication Status epilepticus

NEUROMUSCULAR DISORDERS: High cervical cord injury Poliomyelitis Gullian - barre syndrome Werdnig-Hoffmann syndrome Muscular dystrophies and myopathies Myasthenia gravis Botulism Tetanus Phrenic nerve injury

STRUCTURAL IMPAIRMENT: Severe kyphoscoliosis Flail chest

Large intra thoracic tumour

Pneumothorax or pneumomediastinum

Large pleural effusion, hemothorax

Severe abdominal distention Severe obesity (pickwickian syndrome)

UPPER AIRWAY OBSTRUCTION: Congenital anomalies Intrinsic or extrinsic tumours Epiglottitis Croup (Laryngotracheo bronchitis) Foreign body Post intubation edema, granulation tissue Vocal cord paralysis Vascular ring

LOWER AIRWAY OBSTRUCTION:

Asthma
Bronchiolitis

Foreign body
Lobar emphysema Cystic fibrosis

ALVEOLAR DISORDERS:
Pneumonia Infectious Bacterial, viral, fungal, pnemocystis Chemical aspiration, hydrocarbon smoke inhalation

Pulmonary edema cardiogenic, near drowning,

capillary leak syndrome Massive atelectasis Oxygen toxicity Pulmonary contusion Pulmonary hemorrhage

THANK YOU