Ards gray

Acute Respiratory Distress Syndrome Alice Gray, MD Duke University Medical Center March 21, 2007

Objectives ,[object Object],[object Object],[object Object],[object Object]

ARDS ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Epidemiology ,[object Object],[object Object],[object Object],N Engl J Med. 2005;353:1685-93. Am J Respir Crit Care Med. 1999;159:1849-61.

Most common causes ARDS ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],ARDSnet NEJM 2000:342:1301-8.

Causes of ARDS NEJM 2000;342,18:1334-1349

Risk factors for ARDS ,[object Object],[object Object],[object Object],[object Object],[object Object]

Differential diagnosis ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Excluding other diagnoses ,[object Object],[object Object],[object Object],[object Object]

Acute (Exudative) Phase ,[object Object],[object Object],[object Object],[object Object],[object Object]

Acute Phase - Radiographs NEJM 2000;342,18:1334-1349

Pathological findings ,[object Object],[object Object],[object Object],[object Object]

Acute (Exudative) Phase Expansion of interstitium with macrophages and inflammation Hyaline Membranes Alveolar Filling

Fibroproliferative Phase ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Fibroproliferative phase ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Fibroproliferative phase NEJM 2000;342,18:1334-1349

Fibrosing alveolitis NEJM 2000;342,18:1334-1349.

Recovery phase ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Management of ARDS ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Complications in Managing ARDS patients ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

ARDS Network ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Pulmonary artery catheters ,[object Object],[object Object],[object Object],[object Object],JAMA. 1996;276:889-97. N Engl J Med. 2006:354:2213-24

Ventilator management – ARDSnet protocol ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],NEJM 2000;342:1301-8.

ARDSnet Tidal Volume Study NEJM 2000;342:1301-8.

Positive End-Expiratory Pressure (PEEP) ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],NEJM 2004:351(4):327-336

Other Ideas in Ventilator Management ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],JAMA 1979;242:2193-6. Am J Respir Crit Care Med. 2002;166:801-8

Drug therapy ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Steroids in ARDS ,[object Object],[object Object],[object Object],[object Object],[object Object],JAMA 1998;280:159-65, N Engl J Med 2006;354:1671-84

Steroids in ARDS N Engl J Med 2006;354:1671-84

Other drugs in ARDS ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],N Engl J Med. 1996;334:1417-21. Crit Care Med. 1998;26:15-23.

Fluid management ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

ARDSnet Fluid Management NEJM 2006;354:2564-75.

Keys to management ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Survival and Long Term Sequelae ,[object Object],[object Object],[object Object],[object Object],[object Object]

1 year after ARDS survival ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],NEJM 2003: 348: 683-693

Summary ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

References ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

References ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

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