Acute Respiratory Distress Syndrome




PATHOPHYSIOLOGY OF ACUTE RESPIRATORY DISTRESS SYNDROME (ARDS)



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  • Acute inflammation occurring as a result of either direct or indirect injury



  • Hallmark of acute phase is diffuse alveolar damage via altered permeability of pulmonary endothelial and epithelial cells




    • Leads to accumulation of protein-rich fluid in alveoli



    • Inactivates surfactant



    • Leads to hypoxia and impaired lung compliance






DEFINITIONS



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  • P/F Ratio




    • PaO2/FiO2 is a measure of oxygenation



    • A lower P/F ratio is reflective of more impaired oxygenation



    • Does not incorporate mean airway pressure




  • Oxygenation Index (OI)




    • Measure of oxygenation developed for use in neonates with persistent pulmonary hypertension



    • Recommended for use in pediatric ARDS over P/F ratio


      OI=[meanairwaypressures×FiO2÷PaO2]×100






DIAGNOSTIC CRITERIA



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HISTORICAL DEFINITION





  • Acute lung injury (ALI)




    • Acute onset of respiratory failure



    • Bilateral infiltrates on chest x-ray (CXR)



    • PaO2/FiO2 <300



    • Absence of left ventricular failure




  • Acute respiratory distress syndrome (ARDS)




    • Acute onset of respiratory failure



    • Bilateral infiltrates on CXR



    • PaO2/FiO2 <200



    • Absence of left ventricular failure



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Jan 14, 2019 | Posted by in PEDIATRICS | Comments Off on Acute Respiratory Distress Syndrome
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