Acute Respiratory Failure in Adult (Respiratory Distress Syndrome)

Marion Soriano Fatima Love Ariate

Initially called the adult respiratory distress syndrome, it is now called the acute respiratory distress syndrome because it also affects children Results from increased permeability of the alveolar capillary membrane clinical syndrome is characterized by:
a sudden and progressive pulmonary edema increasing bilateral infiltrates on chest x-ray hypoxemia unresponsive to oxygen supplementation regardless of the amount of PEEP

Causes
Aspiration (gastric secretions, drowning, hydrocarbons) Drug ingestion and overdose Hematologic disorders (disseminated intravascular coagu-lopathy [DIC], massive transfusions, cardiopulmonary by-pass) Prolonged inhalation of high concentrations of oxygen, smoke, or corrosive substances

Causes
Localized infection (bacterial, fungal, viral pneumonia) Metabolic disorders (pancreatitis, uremia) Shock (any cause) Trauma (pulmonary contusion, multiple fractures, head injury) Major surgery Fat or air embolism Systemic sepsis

PATHOPHYSIOLOGY

Modifiable -lifestyle -Diet -Infections -Chemicals -Trauma

Non-modifiable -Age -Gender

Lung injury

Platelet aggregation

Platelet aggregation

Release of Serotonin, Bradykinin, Histamine

Increase of capillary permeability

Pulmonary Edema

Damage to the Type II endothelial cells

Decrease in Surfactant production

Alveolar Collapse

Fibrosis

Signs and Symptoms:

rapid, shallow breathing; dyspnea; and hypoxemia tachycardia intercostal and suprasternal retractions, crackles, and rhonchi restlessness, apprehension, mental sluggishness, and motor dysfunction.

Diagnostic Test

Chest X-Ray

Can reveal which parts of your lungs have fluid in them and whether your heart is enlarged.

CT Scan

Can provide detailed information about the structures within the heart and lungs.

Blood Test

Such as CBC, blood chemistry, blood cultures. These tests help find the cause of ARDS such as an infection

Sputum Cultures

This test looks at the sputum coughed up from your lungs. And can help find the cause of an infection.

Arterial Blood Gas Test

This blood test shows the oxygen level in your blood. A low level of oxygen level in the blood may be a sign of ARDS.

Heart Test

Because signs and symptoms of ARDS are similar to those of certain heart problems, your doctor may recommend Electrocardiogram This test tracks the electrical activity in your heart. Echocardiogram This test can reveal problems with the structures and the function of your heart.

Medical Management

Medication

Antibiotics Given to patients for infection. Such as pneumonia. Steroids To reduce inflammation. Levophed This medication is given to patient with ARDS to support blood pressure and improve oxygenation. Sedatives are given to keep the patient calm and help them tolerate being on a ventilator. Inhaled Medications
pulmonary system

Nitric Oxide Inhaled Nitric Oxide or INO given to improve circulation within the Albuterol Inhaled medication that helps keep the airways open.

Nursing Management

Oxygenation

Supplemental Oxygen For milder symptoms or as

temporary measure. Oxygen may be delivered through a mask that fits tightly over your nose and mouth.

Mechanical Ventilation Most people with ARDS will need

the help of a machine to breathe. A Mechanical Ventilator pushes air into your lungs and forces some of the fluid out of the air sacs.

Fluid and Electrolyte

Carefully managing the amount of intravenous fluid is crucial. Too much fluid can hinder the lungs ability to oxygenate the blood. Too little fluid can make the body dehydrated , making it difficult to send enough blood and oxygen to the organs and extremities.

Adequate Nutrition

The nutritional needs of the critically ill patient with ARDS must also be addressed because the caloric requirement increases due to stress, sepsis, trauma, and use of mechanical Ventilation.
If the nutritional requirements are not met, respiratory function is impaired as result to negative nitrogen balance.

Surgical Management