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ARDS - trauma
1. Acute Respiratory Distress Syndrome.
Case presentation
Dr. Adel Hassan
Sen. Consult. Anesthesiologist
HOD Anesthesia & ICU.
Kalba Hospital,
MOH.
31st March 2014
2.
3. F. 35ys , 300 Kgs, Lt. TIBIA/FIBULA Fx (Impacted In place).
8th D -in pat. w.- after admission, sudden severe hypoxia PH 7.22
PaCO2 =72 mmhg PaO2=43 mmhg HCO36 , Unconscious.
Anesthesia on duty was called to IPW. Supported
ventilation shifted pt. to ICU. Management started as
will be discussed later.
4. Acute Respiratory Failure
• Failure in one or both gas exchange functions:
oxygenation and carbon dioxide elimination
• In practice:
PaO2<60mmHg or PaCO2>46mmHg
• Derangements in ABGs and acid-base status
11. Hypercapnic Respiratory Failure
V/Q abnormality
Increased Aa gradient
Nl VCO2
VCO2
V/Q
Abnormality
Hypermetabolism
Overfeeding
• Increased dead space ventilation
• advanced emphysema
• PaCO2 when Vd/Vt >0.5
• Late feature of shunt-type
• edema, infiltrates
12. Hypercapnic Respiratory Failure
V/Q abnormality
Increased Aa gradient
Nl VCO2
VCO2
V/Q
Abnormality
Hypermetabolism
Overfeeding
• VCO2 only an issue in pts with ltd
ability to eliminate CO2
• Overfeeding with carbohydrates
generates more CO2
13. Hypoxemic Respiratory Failure
Is PaCO2 increased?
Hypoventilation (PAO2 - PaO2)?
Hypoventilation
alone
Respiratory drive
Neuromuscular dz
Hypovent plus
another
mechanism
Shunt
Inspired PO2
High altitude
FIO2
(PAO2 - PaO2) No
NoYes
Is low PO2
correctable
with O2?
V/Q mismatch
No Yes
Yes
14. The Case of Patient ES
77F s/p MVC.
Injuries include multiple L rib fxs, L hemopneumothorax
s/p chest tube placement, L iliac wing fx.
PMH: atrial arrhythmia, on coumadin. INR>2
HD#1
RR 30s and shallow. Pain a/w breathing deeply.
Placed on BiPAP overnight
PID#1
BiPAP 80%: 7.45/48/66/32/+10
15. Hypoxemic Respiratory Failure
Is PaCO2 increased?
Hypoventilation (PAO2 - PaO2)?
Hypoventilation
alone
Respiratory drive
Neuromuscular dz
Hypovent plus
another
mechanism
Shunt
Inspired PO2
High altitude
FIO2
(PAO2 - PaO2) No
NoYes
Is low PO2
correctable
with O2?
V/Q mismatch
No Yes
Yes