Acute Respiratory

Distress Syndrome

South Tipperary General Hospital

Emergency Department
Dr K Dasari
 Lecture Objectives
Definition
Statistics
Classification
Pathophysiology
Aetiology
Clinical features
Management
Complications
 Definition (AECC, 1994)
ARDS was recognized as the most severe form of
acute lung injury (ALI), a form of diffuse alveolar
injury.

ARDS is an acute condition characterized by

bilateral pulmonary infiltrates and severe
hypoxemia in the absence of evidence for
cardiogenic pulmonary edema.

ARDS was defined by a PaO2/FIO2 < 200

(ALI PaO2/FIO2, < 300)
 Berlin Criteria ARDS
ARDS
timing (within 1 wk of clinical insult or onset of
respiratory symptoms)
radiographic changes (bilateral opacities not fully
explained by effusions, consolidation, or
atelectasis)
origin of edema (not fully explained by cardiac
failure or fluid overload)
Severity based on the PaO2/FIO2 ratio on 5 cm of
continuous positive airway pressure (CPAP).
 Classification (Berlin)

The 3 categories:-
Mild PaO2/FIO2 200-300

Moderate PaO2/FIO2 100-200

Severe PaO2/FIO2 100

 Statistics

Mortality 30-40% (70-80% previously)

Incidence range 5-75/100000 per annum

Higher incidence in advancing age

Pathophysiology I
 Pathophysiology II
Exudative Fibroproliferative phases
Damage to alveoli epithelium or microvascular
endothelium leakage of fluid into alveoli
Damaged alveoli are unable clear fluid and
unable produce surfactant alveoli collapses
Cytokines along with platelet sequestration
and activation, are also important in the
development of ARDS
 Aetiology
Sepsis Burns
Pneumonia Pancreatitis
Trauma Near drowning
Lung contusion Inhalation injury
Aspiration (smoke, chlorine)
Multiple blood Large volume fluid
transfusions resuscitation
Drug abuse/overdose
 History
Patients are critically ill, often with
multisystem organ failure, and they may not
be capable of providing historical information
Acute dyspnea and hypoxemia within hours to
days after clinical insult, typically 12-48 hrs.
Early - exertional dyspnoea
Later (rapidly) - severe dyspnoea at rest,
tachypnea, anxiety, agitation, escalating
oxygen requirements.
 Examination
Respiratory - cyanosis, tachypnea, bilateral creps,
oxygen requirements
Cardiac - tachycardia (Exclude signs of cardiogenic
pulmonary edema)
Manifestations of the underlying cause (eg, acute
abdominal findings in the case of ARDS caused by
pancreatitis)
Sepsis - cool skin (peripheral vasoC), hypotension,
febrile or hypothermic
 Investigations
ABG (PaO2/FIO2 < 300)
Exclude cardiogenic process (BNP, ECHO)
ECG
CXR (bilateral pulm. infiltrates)
CT Chest not routine
 Management
Largely supportive care and treatment of
underlying pre-disposing condition
Oxygenation (NIV, Intubation)
Fluid management (aggressive in sepsis, more
balanced other causes of ARDS)
 Complications
Hypoxaemia
Pneumothorax (high ventilation pressures)
Laryngeal problems (intubation)
Tracheostomy
Pulmonary Hypertension
Pulmonary Fibrosis
Infections (VAP, Line sepsis, UTI)
CXR
CT Scan