ARDS stands for Acute Respiratory Distress Syndrome, a condition characterized by rapid onset of widespread inflammation in the lungs leading to impaired gas exchange.
Definition: ARDS is a clinical syndrome characterized by the acute onset of hypoxemia, often after a severe insult, and bilateral infiltrates on chest X-ray despite low to absent pulmonary artery wedge pressure.
Types of ARDS
ARDS Type 1: Characterized by diffuse alveolar damage and extensive edema.
ARDS Type 2: Characterized by patchy alveolar damage and minimal edema.
ARDS Type 3: Characterized by diffuse alveolar damage and normal lung architecture.
Aetiology of ARDS
Severe injury or trauma
Infection (pneumonia, sepsis)
Aspiration of gastric contents
Near-drowning
Transfusions
Burns
Pancreatitis
Cardiac surgery
Ventilatory Management Strategies
Mechanical Ventilation: Goal is to maintain adequate oxygenation and prevent further lung injury.
Positive End-Expiratory Pressure (PEEP): Used to maintain lung volume and prevent atelectasis.
Tidal Volume (VT): Limited to 6 mL/kg to prevent ventilator-induced lung injury.
Rate and Mode: Adjusted based on patient's needs and clinical response.
Pathophysiology
Diffuse Alveolar Damage (DAD): Characterized by hyaline membrane formation, alveolar edema, and inflammation.
Neutrophil Sequestration: Neutrophils accumulate in the lungs and contribute to inflammation and tissue damage.
Investigations
Chest X-ray: Bilateral infiltrates and normal heart size.
Arterial Blood Gas (ABG): Hypoxemia and hypercapnia.
Lung Ultrasound: Used to assess lung aeration and fluid status.
Bronchoalveolar Lavage (BAL): Used to diagnose infection and rule out other conditions.
Complications
Acute Respiratory Failure: Most common complication.
Pulmonary Edema: May occur due to excessive PEEP.
Barotrauma: May occur due to high airway pressures.
Management
Oxygen Therapy: Goal is to maintain adequate oxygenation.
Mechanical Ventilation: Goal is to prevent further lung injury.
Fluid Management: Goal is to avoid fluid overload.
Nutritional Support: Goal is to promote recovery.
Homeopathic Therapeutic Medicines
Arsenicum Album: For acute respiratory distress with anxiety and restlessness.
Chlorophyllin: For acute respiratory distress with bronchospasm.
Iodum: For acute respiratory distress with bronchitis.
Phosphorus: For acute respiratory distress with inflammation.
Clinical Features
Hypoxemia: Most common clinical feature.
Tachypnea: Rapid breathing rate.
Dyspnea: Shortness of breath.
Cough: May occur in some cases.
Fever: May occur in cases of infection.
Treatment
Supportive Care: Goal is to manage symptoms and prevent further lung injury.
Specific Therapy: Goal is to address underlying cause of ARDS.
Surgery: May be required in cases of severe lung injury.