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Syndrome
ACNP Boot Camp 2014
Stephanie Davidson, ACNP-BC
Objectives
• Review the causes and differentials for ARDS
• Briefly discuss the pathophysiology
• Discuss the clinical manifestations of ARDS
• Understand evidence based treatment options
Statistics
• Epidemiology
– Annual incidence: 60/100,000
– 20% ICU patients meet criteria for ARDS
• Morbidity / Mortality
– 26-44%, most (80%) deaths attributed to non-pulmonary
organ failure or sepsis
• Risk Factors
– Advanced age, pre-existing organ dysfunction or chronic medical
illness
– Patient with ARDS from direct lung injury has higher incidence of
death than those from non-pulmonary injury
Levy BD, & Choi AM, Harrison’s Principles of Internal Medicine, 2012
Bernard et al. AJRCCM 1994; 149:818
Rice et al. Chest 2007: 132: 410
June 20, 2012, Vol 307, No. 23
PEEP
Time
Fluid and Catheter Treatment Trial
--No need for routine PAC use is ALI patients
--Support use of conservative strategy fluid management in patients
with ALI
Levy BD, & Choi AM, Harrison’s Principles of Internal Medicine, 2012
Questions ?
References
Acute Respiratory Distress Syndrome Network: Ventilation with Tidal Volumes as
compared with traditional tidal volumes for acute lung injury and the acute
respiratory distress syndrome. New Engl J Med. 2000; 342: 1302-1308.
ARDSNet: Higher versus lower Positive End-Expiratory Pressures in patients with the
acute respiratory distress syndrome. New Engl J Med. 2004; 351: 327-336.
ARDSNet: Efficacy and Safety of Corticosteroids for persistent acute respiratory
distress syndrome. New Engl J Med. 2006; 354: 1671-1684.
ARDSNet: Comparison of Two fluid management strategies in acute lung injury. New
Engl J Med. 2006; 354: 2564-75.
ARDSNet: Pumonary Artery versus Central Venous catheter to guide treatment of
acute lung injury. New Eng J Med. 2006; 354: 2213-2224.
Et al: Acute respiratory distress syndrome: The Berlin Definition. JAMA. 2012;
307(23): 2526-2533.
Ferguson N, et al: High frequency oscillation in early acute respiratory distress
syndrome. New Engl J Med. 2013; 368: 795-805.
Guerin C et al: Prone positioning in severe acute respiratory distress syndrome. New
Engl J Med. 2013; 368: 2159-2168.
References
Levy B.D., Choi A.M. (2012). Chapter 268. Acute Respiratory Distress Syndrome. In A.S.
Fauci, D.L. Kasper, J.L. Jameson, D.L. Longo, S.L. Hauser (Eds), Harrison's Principles
of Internal Medicine, 18e. Retrieved August 17, 2013 from
http://www.accesspharmacy.com.proxy.library.vanderbilt.edu/content.aspx?aID=
9105737.
Meade M, et al: Ventilation Strategy Using low tidal volumes, recruitment maneuvers
and high post end expiratory pressure for acute lung injury and acute respiratory
distress syndrome. JAMA. 2008; 299(6):637-645.
Mercatt M, et al: Post end-expiratory pressure settings in adults with acute lung injury
and acute respiratory distress syndrome. JAMA. 2008; 299(6): 645-655.
Papazian L, et al: Neuromuscular blockers in early acute respiratory distress syndrome.
New Engl J Med. 2010; 363:1107-1116.
RiceTW et al: Comparison of the SpO2/FiO2 Ration and the PaO2/FiO2 Ratio in
patients with acute lung injury or acute respiratory distress syndrome. Chest.
2007; 132: 410-417.
References
Terragan PP et al: Tidal hyperinflation during low tidal volume ventilation in Acute
respiratory distress syndrome. J Resp Crit Care Med. 2007; 175: 160-166
Ware LB, Matthay MA: The Acute Respiratory Distress Syndrome. New Engl J Med.
2000; 342: 1334-1349.
Young D, et al: High frequency oscillation for acute respiratory distress syndrome.
New Engl J Med. 2013; 368:806-813.