Acute Respiratory Disease Syndrome Yuanlin Song, MD
Yuanlin Song, M.D
Definition o Clinical syndrome of severe dyspnea of rapid onset, hypoxemia, and diffuse pulmonary infiltrates leading to respiratory failure SIS Aspiration rauma Pneumonia rauma SARS
Clinical syndrome of severe dyspnea of rapid onset, hypoxemia, and diffuse pulmonary infiltrates leading to respiratory failure. Pneumonia Trauma SARS
Diagnostic criteria o PaO2/fiO2 <300 (ARDS if 200 o Bilateral alveolar or interstitial infiltrates o PCWP<18 mmHg, or no clinical evidence of Increase left atrium pressure
PaO2/fiO2<300 (ARDS if < 200) Bilateral alveolar or interstitial infiltrates PCWP < 18 mmHg, or no clinical evidence of increase left atrium pressure
Classfication Direct lung injury Indirect lung injury neumonla epsis Aspiration Severe trauma Pulmonary contusion Multiple bone fracture Near-drowning Flail chest Toxic inhalation injury Head trauma Multiple transfusion Bu urns Drug overdose Pancreatitis Post-cardiopulmonary bypass
Direct lung injury Indirect lung injury Pneumonia Sepsis Aspiration Severe trauma Pulmonary contusion Multiple bone fracture Near-drowning Flail chest Toxic inhalation injury Head trauma Multiple transfusion Burns Drug overdose Pancreatitis Post-cardiopulmonary bypass
epidemiology o Annual incidence: 30/100, 000 for ALI and 10/100, 000 for ARDS o 10%ICU admission may have acute respiratory allure o Morality: 40-70% worldwide o In China, around 700,000 new cases per year o In Shanghai, mortality was 70% in 2001 o Death number comparable to hiv, cl, breast cancer
Annual incidence: 30/100,000 for ALI and 10/100,000 for ARDS 10% ICU admission may have acute respiratory failure Morality: 40-70% worldwide In China, around 700,000 new cases per year In Shanghai, mortality was 70% in 2001 Death number comparable to HIV, CI, breast cancer
Etiology of ALI/ARDS Sepsis Pneumonia Trauma Multiple transfusion Aspiration Drug over dose Risk factors Old age Chronic alcohol abuse Metabolic acidosis Severity of critical illness Protective factors Diabetes
Sepsis Pneumonia Trauma Multiple transfusion Aspiration Drug over dose Risk factors Old age Chronic alcohol abuse Metabolic acidosis Severity of critical illness Protective factors Diabetes
Pathology of ALI/ARDS ◇ Exudative phase ◇ Proliferative phase ◇ Fibrotic phase
Exudative phase Proliferative phase Fibrotic phase
Pathophysiology Repopulation of Proliferation and Aleolar Gradual differentiation resolution of type ll cell ype l and Ill Resorption of alveolar edema fluid and protein
Treatment Principle 1. Underlying disease control 2. Reduce Ventilator induced lung injury 3. Prevention of venous thromboembolism GI bleeding, catheter infection 4. Prevent and recognition of HAP 5. Support therapy: nutrition, ventilation, fluid antibiotics
Treatment Principle: 1. Underlying disease control 2. Reduce Ventilator induced lung injury 3. Prevention of venous thromboembolism, GI bleeding, catheter infection 4. Prevent and recognition of HAP 5. Support therapy: nutrition, ventilation, fluid, antibiotics
Mechanical ventilation strategy principles 1. Selection of non-invasive and invasive ventiation 2. Management of artificial airways 3. Ventilation mode: IPPV PSV SIMV PRV NAVA 4. PEEP 5. Ventilation parameters: Volume, RR 6. Other methods: HFV. ECMO, PLV
Mechanical ventilation strategy principles 1. Selection of non-invasive and invasive ventialtion 2. Management of artificial airways 3. Ventilation mode: IPPV, PSV, SIMV, PRV, NAVA, 4. PEEP: 5. Ventilation parameters: Volume, RR, 6. Other methods: HFV, ECMO, PLV