Management of Acute Respiratory Distress Syndrome

92 Pages·2015·1.97 MB·English

2015 Winter Anesthesia Conference
Management of Acute Respiratory
Distress Syndrome

Ronald Pearl, MD, PhD
Professor and Chair
Department of Anesthesiology
Stanford University
[email protected]
Disclosures
• No financial disclosures
Learning Objectives
• At the conclusion of the activity participants
should be able to:
– Discuss mechanisms of ventilator-associated
lung injury and how appropriate ventilator
management of the patient with ARDS can
prevent such injury
– Discuss fluid management of the patient with
ARDS in the context of issues of systemic
perfusion
– Recognize complications associated with the
use of high tidal volume, low PEEP ventilation
in the operating room and the ICU
Intraoperative Ventilation in ARDS
• Blum, Anesthesiology 2011; 115:75
U. Michigan database
2005-2009
8.7 ml/kg TV
5 cm PEEP
FIO 0.9
2
PIP ≈ 30 cm
Acute Respiratory Distress Syndrome
• 23 year old woman involved in MVA
– Bilateral chest contusions
– Ruptured spleen
– 15 units PRBC
– Over next 2 days develops diffuse fever,
tachycardia, bilateral infiltrates, hypoxemia
on mechanical ventilation with 100%
oxygen, increased bilirubin
– What is the management and prognosis?

Acute Respiratory Distress Syndrome
• 23 year old man involved in MVA
– Bilateral chest contusions
– Ruptured spleen
– Massive transfusion in the ED
– Over next 2 days develops diffuse fever,
tachycardia, bilateral infiltrates, and
hypoxemia
– What is the management and
prognosis?
ARDS
• Which of the following interventions have
been demonstrated to improve outcome
in the patient with ARDS:
– Tidal volume of 6 mL/kg
– Fluid restriction
– Pulmonary artery catheter monitoring
– Inhaled nitric oxide
– High dose steroids
ARDS
• Ashbaugh, Lancet 1967;12;319
– 12 patients with tachypnea, hypoxemia,
and decreased compliance following
trauma, aspiration, or pulmonary infection
– Improved oxygenation with PEEP
– 60% mortality
– Hyaline membrane formation on autopsy
– “Adult respiratory distress syndrome”
American-European
Consensus Conference (1994)
• Acute lung injury
– a syndrome of inflammation and increased
permeability
– cannot be explained by left atrial or
pulmonary capillary hypertension
– acute in onset and persistent