ARDS WITH SEPTIC SHOCK

Abstract

Acute respiratory distress syndrome (ARDS) is defined by the acute onset of bilateral infiltrates consistent with pulmonary edema, but without evidence of elevated left atrial pressure. The severity of the hypoxemia divides ARDS to:Mild 200 mmHg < PaO2/FIO2 ≤300 mmHg with PEEP or CPAP ≥5 cmH2O, Moderate 100 mmHg < PaO2/FIO2 ≤200 mmHg with PEEP ≥5 cmH2O, Severe PaO2/FIO2 ≤100 mmHg with PEEP ≥5 cmH2O. Septicshock one of predisposing factors of ARDS because of release inflammatory mediators during septic shock leading to activation inflammatory process at level of the lung leading to pulmonary oedema(ARDS). The initial courses of ARDS are characterized by pulmonary abnormalities that typically develop within 48 hours of the inciting event and rapidly worsen. These include dyspnea, tachypnea, and hypoxemia. Physical examination usually reveals tachycardia, cyanosis, tachypnea, and diffuse rales, while arterial blood gases usually detect an acute respiratory alkalosis, hypoxemia, and an elevated alveolar-arterial oxygen gradient. The initial chest radiograph typically has bilateral, fluffy alveolar infiltrates with prominent air bronchograms. Mechanical ventilation is almost universally required. Exclusion Cardiogenic pulmonary edema and other causes of acute hypoxemic respiratory failure with bilateral infiltrates (eg, pneumonia, diffuse alveolar hemorrhage) must be excluded before the diagnosis of ARDS is made. Healthy lungs regulate the movement of fluid to maintain a small amount of interstitial fluid and dry alveoli. In patients with ARDS, this regulation is interrupted by lung injury, causing excess fluid in both the interstitium and alveoli. Consequences include impaired gas exchange, decreased compliance, and increased pulmonary arterial pressure. Patients with ARDS tend to progress through three relatively discrete pathologic stages: the exudative stage, proliferative stage, and fibrotic stage. Management of acute respiratory distress syndrome (ARDS) is supportive, aimed at improving gas exchange and preventing complications while the underlying disease like septic shock that precipitated ARDS is treated. Potential ARDS-specific therapies have been studied; however, they have not been shown to improve clinical ou