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  • 1. Lung Protective Strategies: The Effects of Vt, PEEP & Alveolar Recruitment David Grooms BS, RRT Sentara Norfolk General, Leigh & Bayside Hospitals
  • 2. Understanding ARDS. 2 Types
    • Extrapulmonary ARDS (In-direct)
    • Pulmonary ARDS (Direct)
  • 3. Identifying ARDS.2 Types?
    • Pulmonary ARDS (Direct)
    • Pneumonia: Bacterial or Viral
    • Inhalation of noxious agent
    • Aspiration of Gastric Contents
    • Isolated pulmonary contusion
    • Fat Embolus syndrome
    • Extrapulmonary ARDS (In-direct)
    • Multi-system Trauma
    • Transfusion related ALI
    • Acute pancreatitis
    • Sepsis
    • Post- CABG surgery
    • Hemorrahagic shock
    Kallet, R & Branson, R. Resp. Care Journal, Apr 2007, Vol 52 No 4
  • 4. Characteristics of Extrapulmonary ARDS (In-direct) Viera et al. Am J Respir Crit Care Med 1998:158
  • 5. Contrasts between 2 types of ARDS Kallet, R & Branson, R. Resp. Care Journal, Apr 2007, Vol 52 No 4 >10 usually present Lower inflec. Pt Severely Reduced Reduced Lung Compl. Response to PEEP Recruitment Potential Risk of overdistention Normal Reduced Chest Wall Compliance Pulmonary ARDS Extrapulmonary ARDS Mechanics
  • 6. Characteristics of Extrapulmonary ARDS (In-direct) Viera et al. Am J Respir Crit Care Med 1998:158
  • 7. Contrasts between 2 types of ARDS Kallet, R & Branson, R. Resp. Care Journal, Apr 2007, Vol 52 No 4 >10 usually present Lower inflec. Pt Severely Reduced Reduced Lung Compl. Response to PEEP Recruitment Potential Low Risk of overdistention Normal Reduced Chest Wall Compliance Pulmonary ARDS Extrapulmonary ARDS Mechanics
  • 8. Characteristics of Extrapulmonary ARDS (In-direct) Viera et al. Am J Respir Crit Care Med 1998:158
  • 9. Contrasts between 2 types of ARDS Kallet, R & Branson, R. Resp. Care Journal, Apr 2007, Vol 52 No 4 >10 usually present Lower inflec. Pt Severely Reduced Reduced Lung Compl. Excellent (10-20 cm) Response to PEEP High Recruitment Potential Low Risk of overdistention Normal Reduced Chest Wall Compliance Pulmonary ARDS Extrapulmonary ARDS Mechanics
  • 10. Characteristics of Extrapulmonary ARDS (In-direct) Viera et al. Am J Respir Crit Care Med 1998:158
  • 11. Contrasts between 2 types of ARDS Kallet, R & Branson, R. Resp. Care Journal, Apr 2007, Vol 52 No 4 10 usually present Lower inflec. Pt Severely Reduced Reduced Lung Compl. Excellent (10-20cm) Response to PEEP High Recruitment Potential Low Risk of overdistention Normal Reduced Chest Wall Compliance Pulmonary ARDS Extrapulmonary ARDS Mechanics
  • 12. Characteristics of Pulmonary ARDS (Direct) Viera et al. Am J Respir Crit Care Med 1998:158
  • 13. Contrasts between 2 types of ARDS Kallet, R & Branson, R. Resp. Care Journal, Apr 2007, Vol 52 No 4 10 usually present Lower inflec. Pt Severely Reduced Reduced Lung Compl. Excellent (10-20cm) Response to PEEP High Recruitment Potential High Low Risk of overdistention Normal Reduced Chest Wall Compliance Pulmonary ARDS Extrapulmonary ARDS Mechanics
  • 14. Characteristics of Pulmonary ARDS (Direct) Viera et al. Am J Respir Crit Care Med 1998:158
  • 15. ARDS CT and PV Curve (slow inflation) # 6 -10 0 10
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