Acute respiratory distress syndrome (ARDS)

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  1. Diffuse inflammatory process that results in endothelial damage and leaky capillary exudation into the lung parenchyma
  2. Predisposing conditions: increased ICP, pneumonia, sepsis, long bone fractures, transfusions; may occur in the first 48 hours after trauma
  3. Characterized by:
    1. Acute onset
    2. Bilateral infiltrates on chest x-ray with costophrenic angle sparing: cause high O2 requirements to maintain oxygenation
    3. Differentiate ARDS from cardiogenic pulmonary edema based on pulmonary capillary wedge pressure (PCWP); in cardiogenic edema PCWP >18, in ARDS <18
  4. Acute lung injury (ALI) vs ARDS:
    1. if PaO2:FiO2 < 300 mmHg - ALI
    2. if PaO2:FiO2 < 200 mmHg - ARDS
  5. Treatment:
    1. keep FIO2 < 50% if possible
    2. treat underlying cause
    3. avoid dopamine due to constriction of pulmonary veins which will raise the wedge pressure and increase the exudates into the lungs
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