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Acute respiratory distress syndrome Treatment

Treatment Principles of Acute respiratory distress syndrome: 1. To correct hypoxia: more than 50% of inhaled oxygen concentration to maintain the PaO2 in the 8kPa. 2. To prevent alveolar collapse: mechanical ventilation, positive end-expiratory pressure to the breathing (PEEP) or continuous positive airway pressure breathing. 3. To improve the pulmonary microcirculation, such as use corticosteroids. 4. The elimination of pulmonary edema: restrictions on entry of water, as appropriate, the use of diuretics. 5. The active treatment of the primary disease. 6. To treatment ARDS complications, such as gastrointestinal bleeding, acute liver failure, DIC, infections, heart failure, arrhythmia.

Medication Principles of ARDS: 1. The primary disease treatment (anti-infective, anti-shock, etc.). 2. Use adrenal cortex hormones. 3. In early ARDS, when serum protein concentration had no significant decrease, the main fluid infusion is crystal. 4. If have hypoproteinemia, can add albumin and plasma albumin. 5. If trauma and excessive bleeding, need to blood transfusion. 6. Correct the acid-base imbalance, electrolyte disorders.

Detailed ARDS treatment method include:

1. Respiratory support treatment, to correct hypoxemia:
1) Oxygen therapy: urgent need to correct hypoxia, can be via face mask continuous positive airway pressure (CPAP) oxygen, but most of the needs of mechanical ventilation with oxygen inhalation. Is generally believed that FiO2> 0.6, PaO2 is <8kPa (60mmHg), SaO2 <90%, should to use of positive end-expiratory pressure (PEEP) combination therapy.

2) Mechanical ventilation:

  • positive end-expiratory pressure (PEEP): After clinical practice, PEEP as an important measure to save patient with ARDS. PEEP in ARDS to improve respiratory function, mainly through its end-expiratory pressure breathing so that trapping of the bronchial and alveolar closure opened to improve the functional residual air (FRC). PEEP for 0.49kPa (5cmH2O) when, FRC increased 500ml. With the trapping of alveolar reexpansion, pulmonary static and dynamic lower blood shunt, ventilation / blood flow ratio and diffusing capacity also improved, and extravascular lung edema have a favorable impact on longevity points to improve lung compliance, reduced breathing. PaO2 and SaO2 of the increase in PEEP with increasing output is not affected in mind, this increase in systemic oxygen transport.
  • inverse ratio ventilation (IRV): Inspiratory positive airway pressure to extend the time, enabling gas to enter the obstruction caused by a longer time constant so that the alveolar reexpansion, the resumption of ventilation, and rapid inflation occurred in the alveolar ventilation redistribution into the alveolar ventilation slower to improve gas distribution , the ratio of ventilation and blood flow to increase the diffusion area; shorten the expiratory time, so that to maintain alveolar volume in small airway closure on the alveolar volume, the role of PEEP with similar; IRV can reduce the peak airway pressure of PEEP, higher gas Road, the average pressure (MAP), and PaO2/FiO2 with increased MAP. Extend the same inspiratory pause time at the end of a favorable hemoglobin oxygenation. Therefore, when ARDS patients with poor efficacy in the PEEP may increase test IRV. MAP is still too high to pay attention to the occurrence and impact of barotrauma circulatory function, reduce the side effects of cardiac output, the MAP does not exceed more than 1.37kPa (14cmH2O) appropriate. IRV application, the patient does not feel uncomfortable, can be added or sedation anesthesia.
  • prevention and treatment of complications of mechanical ventilation: mechanical gas itself, the most common and deadly complications of barotrauma. Can be inhaled nitric oxide (NO), R lung membrane oxygenation or high-frequency ventilation, can reduce or prevent barotrauma of mechanical ventilation.

    3) Membrane oxygenator: After mechanical ventilation, oxygen therapy, but the poor effect of respiratory function, can use extracorporeal membrane oxygenation.

    2. The elimination of pulmonary edema:
    1) early use of high-dose glucocorticoids: dexamethasone 40mg, 1 time / 6h, intravenous, or methyl-prednisolone 200 ~ 400mg, once every 6h, iv. Maintain 48 ~ 72h.

    2) improve the microcirculation: phentolamine 5 ~ 10mg 10% glucose 500ml, intravenous infusion, once every 12h, to the expansion of the lung blood vessels, reduce pulmonary wedge pressure and reduce lung congestion.

    3) to maintain fluid balance:

  • limit to the amount of water to maintain a negative balance (daily output> to the volume of 500ml);
  • application of diuretics: furosemide 40mg, an intravenous injection every 6h;
  • cardiotonic applications; pulmonary wedge pressure> 3.3kPa (25mmHg) should be given rapid intravenous injection of digitalis preparations;
  • application of low-salt albumin: effect of suspicious, and more ideas to improve the pulmonary capillary permeability after the grant.

    3. Prevention of alveolar atelectasis:
    In addition to the use of PEEP can reduce alveolar atelectasis, but also can be used surfactant intratracheal instillation or aerosol inhalation in order to improve and reduce alveolar atelectasis group, thus increasing ventilation to improve the low - oxygen hyperlipidemia.

    4. To maintain appropriate blood volume:
    The trauma of excessive bleeding, need to blood transfusion. Avoid excessive blood transfusion, not too speedy flow rate, enter the new blood of the best. Stock more than 1 week of blood micro-particles, can cause micro-embolism, pulmonary capillary endothelial cell damage, we must increase use of micro-filters. Blood volume in the guarantee, under the premise of a stable blood pressure, the volume of requests from mildly negative fluid balance (-500 ~-1000ml / d). To promote regression of edema fluid can be used furostanol thiophene m (furosemide), a daily 40 ~ 60mg. Increased permeability in endothelial cells, the colloid can be interstitial infiltration to increase the pulmonary edema, it should not be in the early ARDS to the colloidal solution.

    5. Application of adrenocorticotropic hormone:
    It has the protection of capillary endothelial cells, to prevent the white blood cells, platelet aggregation and adhesion formation microthrombus wall; the stability of lysosome membrane and reduce complement activity and inhibit cell membrane phospholipid metabolism, reduce arachidonic Synthesis of acid to prevent prostaglandin and thromboxane A2 of life; protection of alveolar type Ⅱ cells secrete surfactant; an anti-inflammatory and interstitial lung to absorb liquid; alleviate bronchospasm; inhibitory role of the late pulmonary fibrosis. At present, that the inhalation of irritant gases, trauma such as fractures caused by fat embolism caused by non-infectious ARDS, hormones can be use in early ARDS.

    6. Nutritional support:
    patients with ARDS at high metabolic state, should be completed in time to add heat and high-protein, high-fat nutrition. As soon as possible to give a strong nutritional support, intravenous supplies, and maintain total caloric intake for the 20 ~ 40kCal/kg.

    • Submitted by Health Studies on Fri, 04/24/2009 - 23:54
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