Medical history (history of illness) is an important component in the diagnosis of adult respiratory distress syndrome (ARDS). Family History What is the general health status of your family members? Are there any diseases in your family that are common? Are there any hereditary diseases in your family? Social history What is your profession? Are … Adult Respiratory Distress Syndrome: Medical History
Respiratory System (J00-J99) Pneumonia (pneumonia) SARS (Severe Acute Respiratory Syndrome; severe acute respiratory syndrome) – in this respiratory infection with one coronavirus (SARS-associated coronavirus, SARS-CoV), atypical pneumonia (pneumonia) occurs; lethality (mortality rate) 11%. Influenza (flu) Cardiovascular system (I00-I99) Left ventricular failure (left-sided heart failure) Pulmonary embolism – detachment of a blood clot (often from a … Adult Respiratory Distress Syndrome: Or something else? Differential Diagnosis
The following are the major diseases or complications that may be contributed to by adult respiratory distress syndrome (ARDS): Cardiovascular System (I00-I99) Acute right heart failure (RHV) due to afterload increase. Symptoms and abnormal clinical and laboratory findings not elsewhere classified (R00-R99). Multi-organ failure (MODS, multi-organ dysfunction syndrome; MOF: multiple organ failure) – simultaneous or … Adult Respiratory Distress Syndrome: Complications
Classification of ARDS according to the Berlin definition (European Society of Intensive Care Medicine, American Thoracic Society, Society of Critical Care Medicine): Start Within one week of onset of risk factors or new or increasing respiratory symptoms. Radiological findings Bilateral diffuse compressions on chest x-ray or chest CT that cannot be explained by pleural effusions … Adult Respiratory Distress Syndrome: Classification
A comprehensive clinical examination is the basis for selecting further diagnostic steps: General physical examination – including blood pressure, pulse, body weight, height; further: Inspection (viewing). Skin, mucous membranes and sclerae (white part of the eye). Abdomen (abdomen) Shape of the abdomen? Skin color? Skin texture? Efflorescences (skin changes)? Pulsations? Bowel movements? Visible vessels? Scars? … Adult Respiratory Distress Syndrome: Examination
Laboratory parameters of 1st order – obligatory laboratory tests. Small blood count Inflammatory parameters – CRP (C-reactive protein) or PCT (procalcitonin). Blood gas analysis (ABG) [To assess transpulmonary oxygen transport, Horowitz oxygenation index (PaO2/FiO2; PaO2 = arterial oxygen partial pressure in mmHg,FiO2 = inspiratory oxygen concentration) is determined: < 200 mmHg (in ARDS)] Liver parameters … Adult Respiratory Distress Syndrome: Test and Diagnosis
Therapeutic Targets Treatment of hypoxia (reduced supply of oxygen to the body). Prevention of further complications Therapy recommendations Mechanical ventilation/lung protective ventilation (see “Further therapy” below). In particularly severe forms of ARDS, if necessary, with initial neuromuscular blockade with cisatracurium (drug from the group of non-depolarizing muscle relaxants) for 48 hours (→ reduction of 90-day … Adult Respiratory Distress Syndrome: Drug Therapy
Mandatory medical device diagnostics. Radiograph of the chest (radiographic thorax/chest), in two planes [bilateral (“bilateral”) infiltrates of noncardiac origin]. Echocardiography (echo; cardiac ultrasound). Optional medical device diagnostics – depending on the results of the medical history, physical examination, laboratory diagnostics and mandatory medical device diagnostics – for differential diagnostic clarification. Pulmonary capillary occlusion pressure (PCWP; … Adult Respiratory Distress Syndrome: Diagnostic Tests
Lung transplantation (LUTX) represents the ultima ratio.
The following symptoms and complaints may indicate adult respiratory distress syndrome (ARDS): The following stages can be distinguished: Stage I Hypoxemia – decreased oxygen levels in the blood. Hyperventilation – increased breathing beyond what is required. Respiratory alkalosis – form of acid-base disturbance that occurs as a result of hyperventilation. Stage II Increasing dyspnea (shortness … Adult Respiratory Distress Syndrome: Symptoms, Complaints, Signs
Pathogenesis (disease development) ARDS describes the acute respiratory failure of the previously lung-healthy individual, which is due to acute disruption of the function of the alveolar (pulmonary alveoli)-capillary (hair vessels) barrier of the lung. Three stages can be distinguished: Exudative, inflammatory (acute) phase – capillary permeability increased, interstitial pulmonary edema (in this case, the fluid … Adult Respiratory Distress Syndrome: Causes
General measures The most important measure is to eliminate the underlying cause. Review of permanent medication due topossible effect on the existing disease. Intensive medical treatment with the following therapeutic measures: Ventilation therapy – lung-protective mechanical ventilation with tidal volume* ≤ 6 ml/kg standard body weight, low peak pressure (< 30 mbar) and PEEP (“Positive … Adult Respiratory Distress Syndrome: Therapy
