Acute Respiratory Distress Syndrome - Orthopaedic Trauma - Lecture Slides, Slides for Orthopedics. Acharya Nagarjuna University
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devaki21 December 2012

Acute Respiratory Distress Syndrome - Orthopaedic Trauma - Lecture Slides, Slides for Orthopedics. Acharya Nagarjuna University

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Acute Respiratory Distress Syndrome, Thromboembolic Disease, Post Traumatic Period, Extravasations of Fluid, Pulmonary Vasculature, Interstitial Space of Lungs, Ards Clinical Definition are some points from this lecture....
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Objectives

Objectives

• Define – ARDS – FES – Thromboembolic Disease

• Understand Etiology & Physiology of each Condition

• Understand – Prevention – Diagnosis – Treatment – Outcomes

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ARDS Acute Respiratory Distress Syndrome

• Acute respiratory failure in the post traumatic period characterized by a decreased PaO2 and a diffuse and often massive extravasations of fluid from the pulmonary vasculature to the interstitial space of the lungs.

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ARDS Clinical Definition – Acute onset of symptoms

– Ratio of PaO2 to FIO2 of 200 mm Hg or less

– Bilateral infiltrates on CXRs

– Pulmonary arterial wedge pressure of 18 mm Hg or less or

no clinical signs of left atrial hypertension

– American-European Consensus Conference (AECC) on ARDS, 94

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ARDS

• Incidence 5% – 8% after polytrauma – Much lower in isolated fracture

• Mortality up to 40%

• Uncommon in Children and the Elderly

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ARDS Common Causes

• Trauma • Massive Transfusion • Embolism • Sepsis • Aspiration • Abdominal Distension

• Pulmonary Edema • Prolonged LOC • Cardiopulmonary

Bypass • Pancreatitis • Major Burns

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ARDS Etiology

• ARDS related to MODS

• Release of inflammatory mediators results in organ dysfunction

Trauma Inflammatory Mediators

Organ Injury

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ARDS PATHOPHYSIOLOGY

• Systemic Inflammatory Mediators

• Damage to Endothelial Lining

• Increased Capillary Permeability

• Fluid Extravasation

• Alveolar Collapse • Decreased Pulmonary

Compliance • Ventilation Perfusion

Abnormalities • Arteriolar Hypoxemia

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ARDS Prevention

• Limiting Blood Loss • Decreasing Transfusion

Requirements • Early Stabilization Of

Unstable Fractures • Early Prophylactic

Mechanical Ventilation Temporary Ex-Fix For Stabilization

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ARDS Treatment

• Ventilator Support – Acceptable ABG’s – Avoid further alveolar damage

• Toxic FIO2 • Barotrauma

• General Organ Support • Research

– Optimal ventilator settings – Pharmalogical agents

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ARDS Outcome

• Significant Cause of Mortality • Major Cause of Death in Patients with the

Lowest ISS scores • 30% - 40% Mortality Rate

– Mortality Rate Slowly Decreasing with Changing & Improving Therapy

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