ARDS: What Works! Todd M Bull MD Associate Professor of Medicine Division of Pulmonary Sciences and Critical Care Division of Cardiology Director Pulmonary Vascular Disease Center University of Colorado, Denver A 42 year old female is admitted after a drug overdose complicated by emesis and aspiration. Intubation, mechanical ventilation, and neuromuscular blockade are initiated in the emergency department: AC, Vt 680, RR 10, FiO2 100%, PEEP 5. She weighs 68kg Ht 6’ Vent mechanics include: PIP 52, Pplat 48, SpO2 86% P/F 54 ABG pH 7.38, PaCO2 36, PaO2 54, SpO2 86% What interventions will improve this patients outcome A. Reduce tidal volume to 360 cc (6cc/kg) B. Early prone ventilation C. Diuresis when hemodynamically stable D. Early Neuromuscular blockade E. All of the above Topics • New definition • Breaths: Little or Big? • Wet or Dry? • Moving or Still? • Upside down or Right side up?
10
Embed
ARDS: What Works! - CEConsultants, LLCthececonsultants.com/images/1B_Bull_ARDS.pdfTopics • New definition • Breaths: Little or Big? • Wet or Dry? • Moving or Still? • Upside
This document is posted to help you gain knowledge. Please leave a comment to let me know what you think about it! Share it to your friends and learn new things together.
Transcript
ARDS: What Works!
Todd M Bull MD Associate Professor of Medicine
Division of Pulmonary Sciences and Critical Care Division of Cardiology
Director Pulmonary Vascular Disease Center University of Colorado, Denver
A 42 year old female is admitted after a drug overdose complicated by emesis and aspiration. Intubation, mechanical ventilation, and neuromuscular blockade are initiated in the emergency department:
What interventions will improve this patients outcome A. Reduce tidal volume to 360 cc (6cc/kg) B. Early prone ventilation C. Diuresis when hemodynamically stable D. Early Neuromuscular blockade E. All of the above
Topics
• New definition • Breaths: Little or Big? • Wet or Dry? • Moving or Still? • Upside down or Right side up?
Ashbaugh 1967
AECC 1994 (ARDS and ALI)
Berlin 2012 JAMA
ARDS
Jama Vol 307 2012
• Acute Lung Injury is out • Still Acute (7 days, most within 72 hrs) • Bilateral opacities (CXR or CT) • Do not need to exclude heart failure
– “Not Explained” by CHF – “Objective assessment” (echo) if no clear
A 42 year old female is admitted after a drug overdose complicated by emesis and aspiration. Intubation, mechanical ventilation, and neuromuscular blockade are initiated in the emergency department:
What interventions will improve her outcome A. Reduce tidal volume to 360 cc (6cc/kg IBW) B. Early prone ventilation C. Diuresis when hemodynamically stable D. Early Neuromuscular blockade E. All of the above
A 42 year old female is admitted after a drug overdose complicated by emesis and aspiration. Intubation, mechanical ventilation, and neuromuscular blockade are initiated in the emergency department:
What interventions will improve this patients outcome A. Reduce tidal volume to 360 cc (6cc/kg) B. Early prone ventilation C. Diuresis when hemodynamically stable D. Early Neuromuscular blockade E. All of the above