ARDS: Causes, Symptoms, and Management

This document provides an overview of Acute Respiratory Distress Syndrome (ARDS), including its causes, symptoms, and management. It discusses the risk factors, pathogenesis, and effects of obesity on ARDS. The document also explores the use of mechanical ventilation and fluid resuscitation in treating ARDS, as well as the importance of individualized approaches to patient care. Overall, it offers valuable insights into the diagnosis and management of this critical condition.

Project with scenario about ARDS

TABLE OF CONTENTS
MAIN BODY...................................................................................................................................1
REFERENCES................................................................................................................................8

MAIN BODY
Billy is a 32 year male who has been admitted to the ICU because he was suspected of
overdosing of tricyclic anti- depressants. Billy is an obese person and also has a history of
chronic back pain and depression for which he has been taking oxycodone. The key observation
of the Billy were temperature 35.5 degree Celsius, blood pressure 100/50 mmHg, heart rate 140
bpm, oxygen saturation 92%, GCS 8, Arterial blood gas pH 7.21, HCO 26 mEq/L, etc.
Acute respiratory distress syndrome tends to occur in those individuals who in turn are
critically ill. Acute respiratory distress syndrome tends to increase with age with high degree of
severity of illness. It is a severe lung condition and it usually tends to happen when the fluid fill
up within the lungs and tends to lower the degree of oxygen and further increases the carbon
dioxide within the bloodstream (Bellani & et.al. (2016)). Acute respiratory distress syndrome
tends to prevent the other organs or part of the body from getting the right amount of oxygen
which the part of the organ tends to need in order to function properly. This eventually leads to
organ failure. Acute respiratory distress syndrome is a life threatening and emergency condition
for an individual.
The key symptoms associated with the acute respiratory distress syndrome tends to
include rapid breathing, muscle fatigue, low degree of blood pressure, labour pain, discoloured
skin, discoloured nails, fever, headaches, fast pulse rate, hacking cough, dry cough and mental
confusion, etc. Acute respiratory distress syndrome is usually caused by the damage to tiny blood
vessels in lungs (Khemani & et.al. (2015)). Fluid from these vessels tends to leak into air sacs of
lungs. The air sacs are referred to as an effective measure where the oxygen enters and also
carbon dioxide is removed from the blood.
There are various set of clinical disorders which is mainly related with the acute
respiratory distress syndrome. The pathogenesis tends to highly involve high degree of
inflammatory injury which results in lung epithelium and endothelium which results in high
degree of cause which results in rise in the lung vascular (Pham & Rubenfeld, (2017)). Acute
respiratory distress syndrome tends to occur when the fluid has been building up in alveoli of
lungs. The fluid in turn tends to keep the lungs filling up with enough air which eventually
results in decrease in the oxygen and increase in the carbon dioxide. Acute respiratory distress
syndrome is mainly a part of the overwhelming inflammatory response which results in injury
(Rimensberger, Cheifetz & Pediatric Acute Lung Injury Consensus Conference Group. (2015).
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Inflammatory mediators tends to severely destroy the alveolar capillary membrane. This in turn
tends to largely increase the permeability which results in the destruction of the key essential
functions. Subsequently, a pulmonary hypertension and pulmonary oedema has been developed.
Moreover, it also results in the decrease in the lung compliance, difficulty in gas exchange and
hypoxia. Acute respiratory distress syndrome has resulted alveoli to become fibrotic which in
turn eventually results in stiffening and scarring of the capillaries (Silva, & et.al. (2016)). Loss of
the pulmonary surfactant tends to highly contribute towards decrease in the lung compliance,
difficulty in gas exchange and hypoxia. Moreover, continued poor lung compliance, increased
hypoxia and increase in the pulmonary hypertension results in high degree of mortality because
of acute respiratory distress syndrome.
ARDS risk factors mainly comprises of direct lung injury, illness and injuries (Schmidt &
et.al. (2015)). One of the most significant risk factor for acute respiratory distress syndrome is
sepsis. As per the specific case scenario, Billy has the history of depression and chronic back
pain.
High degree of positive end- expiratory pressure (PEEP) within the individual is considered to be
as one of the most significant cause of the acute respiratory distress syndrome within the patient.
PEEP is considered to be as one of the most prominent measure because it tends to highly result
in appropriately maintain the above atmospheric pressure which results at the end of the
exhalation (Modrykamien, & Gupta, (2015, April)). The PEEP of more than 5 cmH2O is applied
in order to effectively improve the hypoxemia which helps in reducing the ventilator related lung
injury within the patient.
Partial pressure of carbon dioxide is also known as paco2 whose normal range tends to
vary from 38 to 42 mm Hg, arterial blood pH normal range is from 7.38 to 7.42. Oxygen
saturation (SaO2) normal range is from 94% to 100% Bicarbonate (HCO3) normal range is from
22 to 28 mEq/L. If the paco2 is more than 7.40 then it states that, acidosis is present. The value
which is consistent with the pH is referred to as the PaCO2 (Neto, & et.al (2016)).
Aspiration and pneumonia in turn are considered to be as the key risk factors which in
turn results in the development of the acute respiratory distress syndrome. As per the specific
case scenario, Billy was weighing 160 kg and has the height of 172 cm. However, Billy was
obese. This is considered to be as one of the most significant factor which in turn eventually
results in the development of the acute respiratory distress syndrome (Cardinal-Fernández,
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Correger, Villanueva, & Rios, (2016)). Hence, individuals who in turn are obese tend to
experience high degree alterations within the baseline of the pulmonary mechanics. Obesity
within the person in turn eventually result in decreased lung volumes, airflow obstruction and
impaired gas exchange. The patients who in turn tends to have significant level of respiratory
failure and with obesity in turn tends to have high degree of specific management challenges
associated with acute respiratory distress syndrome (Tiruvoipati & et.al (2016)). Increasing level
of obesity and the high degree of variable effects of obesity associated with respiratory
mechanics and acute respiratory disease syndrome pathophysiology.
Individualized approach to the management of the obese patient with acute respiratory
disease syndrome is considered to be as one of the most significant. The key effects of obesity on
the patient in turn results in high degree of respiratory issues within the individual person.
Respiratory system management is considered to be highly prominent for the individuals who are
obese (Rozencwajg, Pilcher, Combes, & Schmidt (2016)). Individualized approach is considered
to be highly significant because it is very prominent in decreasing the risk associated with the
ventilator induced lung injury. Personalized approach is highly significant because it is highly
significant in improving the care results and health outcomes of the patient who has been
suffering from acute respiratory distress syndrome. Physiological alterations and anatomic
changes are experienced by the obese people. This in turn largely influence the pharynx, chest
wall, face, neck and lungs. Moreover, excessive abdominal fat in turn largely increases the risk
of abdominal pressure. It has been examined that, atelectasis formation has resulted in increase in
base line oxygen consumption and also iatrogenic ventilator management which eventually leads
to high incidence of acute respiratory disease syndrome among the obese patients (Management
of obese patients with ARDS, 2020). There is also an increased prevalence of gastroesophageal
reflux disease which results in increased aspiration incidence at the time of intubation.
The examination of the Billy tends to state that, temperature 35.5 degree Celsius, blood pressure
100/50 mmHg, heart rate 140 bpm, oxygen saturation 92%, GCS 8, Arterial blood gas pH 7.21,
HCO 26 mEq/L, etc. The normal arterial PH tends to highly range from 7.35 to 7.45. The arterial
blood gas PH of the Billy is estimated to be 7.21, PaCao2 is 90 mmHg, SaO2 is 94%, HCO3 is
26mEq/L and the GCS is estimated to be 8. There has been a saturation in the oxygen level
which effects the 92% breathing. The respiratory rate of the Billy was estimated to be 22 b per
minute. The normal oxygen range tends to include 80 to 100 mmHg. PAO2 is considered to be
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very prominent because it is very useful in effectively providing the health care practitioners
about the oxygenation status of Billy. The PAO2 and FiO2 ratio is more than 100 which in turn
eventually tends to state that, Billy has high degree of severe acute respiratory system.
Mechanical ventilation is considered to be as one of the most effective and prominent approach
which in turn is considered to be as a life saving treatment for the acute respiratory distress
syndrome (Yadav, & Kor, (2015)). This can be significantly done with the help of effective
oxygenation, normalizing the base of the acid, ventilation, effective support, rest within the
respiratory muscles, etc. are considered to be as the key relevant measure which in turn helps in
effectively treating patient with acute respiratory distress syndrome. The use of mechanical
ventilation results in the effective correction within the gas exchange which in turn can be caused
by the worsening condition s of the inflammatory response. Moreover, a strategy by effectively
employing high rate of PEEP with low degree of tidal volume is an effective ventilation
mechanism for the acute respiratory distress syndrome. It is very useful in effectively minimizing
the key additional damage associated with maintain adequate gas exchange (Rimensberger,
Cheifetz & Pediatric Acute Lung Injury Consensus Conference Group. (2015)). Moreover,
synchronized intermittent mechanical ventilation with effective volume control is of significant
importance because it is very useful in treating the patient with acute respiratory distress
syndrome. This mechanical ventilation is considered to be very prominent for the Billy because
it helps in taking various spontaneous breaths which however is very significant in reducing the
reducing the respiratory muscle atrophy, improving the ventilator synchrony, reduction in the
barotrauma risk and is considered to be very significant in breath stacking within the Billy.
Volume control is considered to be highly significant within the patient who has acute
respiratory distress syndrome. Volume control ventilation approach is highly significant because
it helps in traditionally controlling the ventilation mode. It is useful in controlling the anaesthesia
and it also helps in delivering preset tidal volume within constant flow at an effective preset
respiratory rate. Synchronized intermittent mechanical ventilation is one of the most effective
approach because it is very useful in enabling the partial mechanical assistance (Summers &
et.al. (2016)). This is one of the most significant method because it helps in providing
appropriate set of number of breaths at fixed degree of tidal volume which in turn tends to
effectively trigger the spontaneous degree of breath within an individual. On the other hand,
pressure control ventilation is an effective ventilator which is very useful in generating the preset
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pressure within preset inspiratory time. The pressure which is maintained is constant and the
flow is in decelerating.
After the 24 ours of the admission of the Billy within the ICU. The key observations of
the Billy tends to comprise of temperature at 39 degree Celsius, heart rate with Sinus
Tachycardia is 130 b/ minute. Moreover, it has been observed that, arterial blood pressure in turn
tends to highly comprise of 85/55 mmHg. The pulse pressure variation was observed to be 15%.
The central venous pressure was observed to be 5mmHg and the urine output is 20 mls for last
hour and 80 ml for past 4 hours. It has been observed that, there is a bounding peripheral pulses.
Fluid resuscitation is considered to be as the medical practice which is useful in replenishing
bodily fluid which has been lost due to sweating, fluid shifts, bleeding or any other pathologic
procedure (Chen, & Ware, (2015)). There are various range of fluids which in turn has been used
at the time of fluid resuscitation.
Sepsis is a life threatening condition which is the response to the infection. Sepsis occurs
when the body tends to response to certain set of chemicals which can damage various multiple
organs of the body.
Vasopressor management in turn are considered to be as the key medications which in
turn has been used in creation of the vasoconstriction. It is considered to be highly prominent
because it is very useful in increasing the cardiac contractility (Burrell & et.al (2017)).
Moreover, Vasopressor management is very prominent because it helps in decreased shock and
perfusion to the key vital organs. It is highly prominent in death or multi- organ dysfunction.
Intravascular fluid mass and massive vasodilation fluid loss in turn has eventually resulted in loss
of the sepsis and it also tends to have high degree of significant effect on the cardiovascular
system of the Billy. Positive pressure ventilation in turn tends to effectively increase the
intrathronic pressure.
Fluid resuscitation and Vasopressor management in turn are considered to be as the key
mainstay treatment which eventually helps in the management of the sepsis. The key prominent
measure of the fluid resuscitation is to prominently restore the intravascular volume which helps
in improving the cardiac output and it is also very useful in improving the cardiac output and it
also helps in supporting the oxygen delivery to the key vital organs of the patient who has been
suffering from acute respiratory distress syndrome (Flori, Dahmer, Sapru, Quasney, & Pediatric
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Acute Lung Injury Consensus Conference Group. (2015)). Moreover, effective fluid
resuscitation within the Billy because it is considered to be very prominent in improving the
cardiac output and it is also very useful in supporting oxygen delivery. It helps in transferring
oxygen to the key vital parts of the body. Moreover, fluid resuscitation within the Billy is highly
associated with the seeking high degree of improvement in effectively decreasing the
tachycardia.
As per the specific guideline, maintaining of the specific set of fluid is considered to be
highly important because it is very prominent. Various range of small trials is highly significant
because it helps in improving the care results and outcomes of the patient who in turn tends to
have acute respiratory distress syndrome (Nanchal, & Truwit, (2018)). Primary acute respiratory
distress syndrome due to aspiration, pneumonia, which can be effectively treated with fluid
resuscitation. Secondary acute respiratory distress syndrome because of inflammation tends to
require initial fluid and also potential vasoactive drug therapy which is significant in initial
treatments to improve the patient outcome with ASDR (Hodgson, & et.al (2016)).
The management of the fluid within the patient with simplified conservative protocols for
acute respiratory distress syndrome. As per the, Fluid and Catheter Treatment Trial of the
National Institutes of Health Acute Respiratory Distress Syndrome Network, there seems to be a
conservative fluid protocol which has resulted in a low accumulative balance of fluid. Moreover,
ARDS Network carry out study with the help of simplified conservative fluid protocol. One of
the key objective of the study is to effectively compare the enactment of FACTT Conservative,
FACTT Lite and FACTT Liberal protocols (Cardinal-Fernández, Correger, Villanueva, & Rios,
(2016)). The key participants of this study are 503 key subjects which has been managed with
FACTT Conservative, 1124 subjects with FACTT lite and 497 subjects with FACTT liberal. The
key setting was the ICU related with acute respiratory distress. Retrospective comparison related
with the FACTT Conservative, FACTT Lite and FACTT Liberal protocols. Fluid management
intervention has been taken place. It has been effectively concluded that, FACTT Lite tends to
have high degree of cumulative fluid balance when compared with the FACTT Conservative. It
tends to have equivalent clinical and appropriate safety outcomes. Moreover, it has been sought
to summarize that, FACTT Lite is considered to be as a substitute to FACTT Conservative which
is very useful in fluid management for the Acute Respiratory Distress Syndrome.
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Mechanical ventilation management for Acute Respiratory Distress Syndrome tends to
carry out the study with the help of using effective retrospective observational design approach.
Total of around 168 patients were the key participants while carrying out the study. The patients
have been treated with extracorporeal membrane oxygenation for ASDR. The mechanical
intervention is considered to be as the key intervention strategy for treating Acute Respiratory
Distress Syndrome. The key significant objective is to treat the patients who has Acute
Respiratory Distress Syndrome with the use of extracorporeal membrane oxygenation and
mechanical ventilation.
Fluid therapy is considered to be highly beneficial because it is very useful in attaining the
best possible care results and outcomes for the patient who has been suffering from Acute
Respiratory Distress Syndrome. Continued degree of positive balance is considered to be highly
detrimental for the individual person (Cardinal-Fernández, Correger, Villanueva, & Rios,
(2016)).
The key primary intervention for the Acute Respiratory Distress Syndrome is to provide
effective oxygen to the various key organs of the patient. It is very useful in ensuring that, the
patient in turn tends to effectively focus on providing oxygen to various parts of the body. It is
very useful in preventing organ failure (Rozencwajg, Pilcher, Combes, & Schmidt (2016)). A
mechanical ventilation machine is very useful because it helps in forcing air into the lungs. It
also helps in reducing fluid within the air sacs. The range of fluids are effectively used at the
time of fluid resuscitation which is considered to be very prominent in effectively retaining the
blood vessels within the individual patient.
Vasopressor management is considered to be highly significant because it helps in
increasing the cardiac contractility. Use of systemic vascular resistance helps in effectively
increasing the arterial pressure. This eventually leads to increased degree of perfusion to the
various organs of the body. The major vasopressors comprises of norepinephrine, phenylephrine,
epinephrine and vasopressin (Modrykamien, & Gupta, (2015, April)). Vasopressors mechanism
is prominent because it very significant in increasing the SVR which increases contractility
which induces vasoconstriction peripherally.
However, Fluid resuscitation and Vasopressor management in turn are considered to be as
the key mainstay treatment which eventually helps in the management of the ASDR (Cardinal-
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Fernández, Correger, Villanueva, & Rios, (2016)). It is very useful in managing the fluids within
the body in order to impart oxygen to various organs of the body.
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REFERENCES
Books and Journals
Bellani, G & et.al. (2016). Epidemiology, patterns of care, and mortality for patients with acute
respiratory distress syndrome in intensive care units in 50 countries. Jama, 315(8), 788-800.
Burrell, A. J. C & et.al (2017). The impact of venovenous extracorporeal membrane oxygenation
on cytokine levels in patients with severe acute respiratory distress syndrome: a prospective,
observational study. Critical Care and Resuscitation, 19(Supplement 1), 37.
Cardinal-Fernández, P., Correger, E., Villanueva, J., & Rios, F. (2016). Acute Respiratory
Distress: from syndrome to disease. Medicina Intensiva (English Edition), 40(3), 169-175.
Chen, W., & Ware, L. B. (2015). Prognostic factors in the acute respiratory distress
syndrome. Clinical and translational medicine, 4(1), 23.
Dalton, H. J., & Macrae, D. J. (2015). Extracorporeal support in children with pediatric acute
respiratory distress syndrome: proceedings from the Pediatric Acute Lung Injury Consensus
Conference. Pediatric Critical Care Medicine, 16(5_suppl), S111-S117.
Flori, H., Dahmer, M. K., Sapru, A., Quasney, M. W., & Pediatric Acute Lung Injury Consensus
Conference Group. (2015). Comorbidities and assessment of severity of pediatric acute
respiratory distress syndrome: proceedings from the Pediatric Acute Lung Injury Consensus
Conference. Pediatric Critical Care Medicine, 16(5_suppl), S41-S50.
Hodgson, C & et.al (2016). Recruitment manoeuvres for adults with acute respiratory distress
syndrome receiving mechanical ventilation. Cochrane Database of Systematic Reviews, (11).
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incidence, and epidemiology: proceedings from the Pediatric Acute Lung Injury Consensus
Conference. Pediatric Critical Care Medicine, 16(5_suppl), S23-S40.
Modrykamien, A. M., & Gupta, P. (2015, April). The acute respiratory distress syndrome.
In Baylor University Medical Center Proceedings (Vol. 28, No. 2, pp. 163-171). Taylor &
Francis.
Nanchal, R. S., & Truwit, J. D. (2018). Recent advances in understanding and treating acute
respiratory distress syndrome. F1000Research, 7.
Neto, A. S & et.al (2016). Associations between ventilator settings during extracorporeal
membrane oxygenation for refractory hypoxemia and outcome in patients with acute respiratory
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distress syndrome: a pooled individual patient data analysis. Intensive care medicine, 42(11),
1672-1684.
Neto, A. S & et.al (2016). Epidemiological characteristics, practice of ventilation, and clinical
outcome in patients at risk of acute respiratory distress syndrome in intensive care units from 16
countries (PRoVENT): an international, multicentre, prospective study. The Lancet Respiratory
Medicine, 4(11), 882-893.
Pham, T., & Rubenfeld, G. D. (2017). Fifty years of research in ARDS. The epidemiology of
acute respiratory distress syndrome. A 50th birthday review. American journal of respiratory
and critical care medicine, 195(7), 860-870.
Rimensberger, P. C., Cheifetz, I. M., & Pediatric Acute Lung Injury Consensus Conference
Group. (2015). Ventilatory support in children with pediatric acute respiratory distress
syndrome: proceedings from the Pediatric Acute Lung Injury Consensus Conference. Pediatric
Critical Care Medicine, 16(5_suppl), S51-S60.
Rozencwajg, S., Pilcher, D., Combes, A., & Schmidt, M. (2016). Outcomes and survival
prediction models for severe adult acute respiratory distress syndrome treated with
extracorporeal membrane oxygenation. Critical Care, 20(1), 392.
Schmidt, M., & et.al. (2015). Mechanical ventilation management during extracorporeal
membrane oxygenation for acute respiratory distress syndrome: a retrospective international
multicenter study. Critical care medicine, 43(3), 654-664.
Silva, L., & et.al. (2016). Acute respiratory distress syndrome in burn patients: incidence and
risk factor analysis. Annals of burns and fire disasters, 29(3), 178.
Summers, C & et.al. (2016). Incidence and recognition of acute respiratory distress syndrome in
a UK intensive care unit. Thorax, 71(11), 1050-1051.
Tiruvoipati, R & et.al (2016). Early experience of a new extracorporeal carbon dioxide removal
device for acute hypercapnic respiratory failure. Critical Care and Resuscitation, 18(4), 261.
Yadav, H., & Kor, D. J. (2015). Platelets in the pathogenesis of acute respiratory distress
syndrome. American Journal of Physiology-Lung Cellular and Molecular Physiology, 309(9),
L915-L923.
Online
Management of obese patients with ARDS. 2020. [ONLINE]. Available through<
https://healthmanagement.org/c/icu/news/management-of-obese-patients-with-ards>
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