Question

ARDS is frequently associated with ventilatory support. What current methods may be employed to minimize the risk and/or effect of ventilatory support as a contributing factor to ARDS? Why?  

Answer 1

DEFINITION

Condition in which fluid collects in the air sacs of the lungs, depriving organs of oxygen.

Acute respiratory distress syndrome (ARDS) can occur in those who are critically ill or who have significant injuries. It is often fatal, the risk increasing with age and severity of illness.

The acute respiratory distress syndrome (ARDS) is a common cause of respiratory failure in critically ill patients and is defined by the acute onset of non cardiogenic pulmonary oedema, hypoxaemia and the need for mechanical ventilation. ARDS occurs most often in the setting of pneumonia, sepsis, aspiration of gastric contents or severe trauma and is present in ~10% of all patients in intensive care units worldwide.

Severe ARDS is often associated with refractory hypoxemia, and early identification and treatment of hypoxemia is mandatory. For the management of severe ARDS ventilator settings, positioning therapy, infection control, and supportive measures are essential to improve survival.

inadequate tissue oxygenation as well as excessive oxygen administration (with expression of oxygen reactive species) can both be harmful.

• A careful balance based on precise control of arterial oxygenation including the acceptance of a “safe” threshold may avoid deleterious hypoxia as well as hyperoxia-associated injury. It remains to be evaluated in further studies whether selected biomarkers may help identify tissue hypoxia in the individual patient.
• Heating and humidifying the inspiratory gas with heated humidifiers or heat and moisture exchangers compensates for the bypassed humidification/heating mechanisms and prevents associated complications .
• Heat and moisture exchangers are widely used because of low cost, simple handling, and condensate elimination from the breathing circuit.
• Early detection of infection and preventing them with broad-spectrum antibiotics.
• Laboratory examination for diagnosis of infection such as BAL culture, blood culture, CT, ABG etc;