ACUTE RESPIRATORY

DISTRESS SYNDROME

(Kompetensi 3B)
Definition

• 1994 American-European Consensus

Conference (AECC) on ARDS
definition:
– Acute onset of symptoms
– Ratio of PaO2 to FIO2 of 200 mm Hg or
less
– Bilateral infiltrates on CXRs
– Pulmonary arterial wedge pressure of 18
mm Hg or less or no clinical signs of left
atrial hypertension
Causative Factors in ARDS

PRIMARY HOST
INJURY RESPONSE

CONSEQUENCES
OF THERAPY
 SPECTRUM OF LUNG
“INJURY”

Cardiogenic
pulmonary ALI ARDS
oedema

Altered P/F RATIO 200 - 300 P/F RATIO < 200

Starling’s
Forces
Clinical features

• Tachypnea, tachycardia, hypoxia,

and respiratory alkalosis are typical
early clinical manifestations
• Usually followed by the
appearance of diffuse pulmonary
infiltrates and respiratory failure
within 48 hours.
Course of disease (1)

• Exudative phase:
– Occurs within hours after initial pulmonary
insult
– Usually lasts 2-7 days
– Hyaline membranes, loss of the alveolar
epithelium, edema, & hemorrhage
• Proliferative phase
– Usually 7-28 days after initial pulmonary
insult
– Proliferation of type 2 pneumocytes,
widening of septa & interstitial fibroblast
proliferation
Course of disease (2)

• Late proliferative or fibrotic phase:

– Deposition of collagen and
proteoglycans.
– Fibroblast proliferation

• Interstitial fibrosis develops in

some patients.
 Radiographic abnormalities

• Due to alveolar epithelial injury, or diffuse

alveolar damage, that causes leakage of
protein-rich fluid into the alveolar spaces.
 Chest X-ray

• Exudative phase: progression from diffuse bilateral

interstitial infiltrates to diffuse, fluffy, alveolar
opacities +/- air bronchograms
– White out
– Ground glass opacities

• Proliferative and fibrotic phase: a more

heterogeneous, linear or reticular pattern.
 Chest X-Ray

• To help distinguish from cardiogenic

pulmonary edema: often a lack
cardiomegaly, obvious pleural effusions, and
vascular redistribution.
• Radiographic findings tend to stabilize and if
further worsening occurs after 5-7 days,
another process should be considered.
http://www.lumen.luc.edu/lumen/MedEd/Radio/curriculum/Mechanisms/ards.htm
Management

• Treat underlying cause

• Nutrition
• Oxygenation
• Ventilation
• Position (PRONE POSITION)
• Fluid management
• Miscellaneous
THANK YOU